When Carlos Mejia-Bonilla was detained by immigration authorities a few years ago, he told the health care staff at the Hudson County Correctional Facility in New Jersey that he was taking medicine for a range of conditions, including diabetes, anemia, high blood pressure and cirrhosis of the liver.
Ten weeks later, he died of gastrointestinal bleeding.
An internal investigation by U.S. Immigration and Customs Enforcement found that Bonilla was denied necessary medical care. The care he did receive in ICE detention was "outside the scope of safe practice," ICE's investigators concluded, and contributed to his death.
Now the same detention facility in New Jersey is grappling with an outbreak of positive COVID-19 cases among its staff and detainees. And immigrant advocates fear the pandemic will only exacerbate deep-seated problems with medical care at ICE detention facilities.
"It was a broken system already," said Katherine Hawkins, a senior legal analyst at the Project On Government Oversight, or POGO, in Washington, D.C. "And unfortunately, ICE has not been responding with urgency."
How widespread is the virus?
NPR has reviewed internal ICE documents obtained by POGO through Freedom of Information Act requests. The documents reveal new details about the deaths of two immigrants in ICE detention during the first year of the Trump administration in 2017.
In the case of Bonilla, investigators with ICE Health Services Corp. — which operates or oversees health care operations at detention centers nationwide — determined that inadequate medical care contributed to the detainee's death.
In the other case — at the LaSalle ICE Processing Center in Louisiana — physicians who reviewed the documents for POGO said a lack of timely medical care was likely a factor.
The two detention facilities highlighted in a POGO report released Wednesday have confirmed cases of coronavirus among staff and detainees. So far, the Hudson County jail has reported four staff members have died from COVID-19. ICE says that nine detainees and one agency employee tested positive. At LaSalle, five staff members and seven ICE detainees have tested positive.
Nationwide, ICE says 425 detainees have tested positive for the coronavirus as of Tuesday.
But immigrant advocates fear the virus is much more widespread than limited testing has revealed. ICE has tested only a small fraction of those in its custody. As of Tuesday, ICE said it had tested only 705 detainees out of more than 30,000 in detention.
Immigration and Customs Enforcement says it is taking steps to ensure the health and safety of its detainees during the coronavirus pandemic.
The agency says it has released nearly 700 people from detention, and is considering releasing other "potentially vulnerable populations," according to a spokesman. The agency says its detained population has dropped by more than 4,000 since the beginning of March, to just over 30,000.
"ICE is committed to ensuring that everyone in our custody receives timely access to medical services and treatment," an agency spokesman said in a statement. "While any death in ICE custody is unfortunate, fatalities in ICE custody, statistically, are exceedingly rare."
ICE officials declined to comment on whether the two detainees who died in 2017 received adequate care.
Immigrant advocates say conditions in ICE detention make detainees particularly vulnerable to coronavirus and note that people with underlying health conditions may be more at risk of severe illness from COVID-19. The two detainees who died three years ago had severe pre-existing medical conditions.
"They're held in very crowded conditions in a setting that is designed for control, but certainly not for hygiene or to prevent transmission of an infectious disease," said Dr. Nathaniel Kratz, an instructor at Columbia University and a physician at New York-Presbyterian Hospital.
Kratz has evaluated detainees at the Hudson County jail and other ICE detention facilities through his work with New York Lawyers for the Public Interest, which this week published its own report on conditions in ICE facilities.
"I can also speak to the substandard levels of medical care and attention that they received there," Kratz said, which is "deeply concerning given the current crisis."
"Serious and worsening condition"
Carlos Mejia-Bonilla was 43 when he died. The Salvadoran native co-owned a construction business on Long Island, N.Y., his family says, where he had lived for close to 25 years. While Bonilla was in federal custody when he died, he was being detained at the Hudson County jail in Kearny, N.J., which has contracted with immigration authorities to hold detainees for decades.
After Bonilla's death, county officials built an upgraded health care facility at the jail and hired a new contractor to provide care to detainees. When Hudson County terminated the previous contract in 2018, County Executive Tom DeGise cited a recent suicide at the jail, as well as "other failures to meet an appropriate standard of care."
But immigrant advocates are still concerned about conditions at the Hudson County jail.
"Our concern is that this virus is spreading and these are facilities that have a history of not meeting the medical needs of the people being detained," said Amber Khan, director of health justice at New York Lawyers for the Public Interest.
The group has sued Hudson County on behalf of Bonilla's family. Khan says conditions in ICE detention have not improved since 2017, when Bonilla died.
"What we've seen overall in these facilities ... is a really serious and worsening condition for what folks are facing," Khan said. "And that is denial of medical care, overcrowding, a refusal of basic health-related needs."
Advocates say they've seen such conditions at ICE detention facilities across the country. And they worry ICE is still detaining many immigrants who are older and sicker.
"People are terrified"
Under the Trump administration, ICE has been more likely to detain immigrants with serious medical or mental health concerns that previous administrations might have decided to release, says Katherine Hawkins with POGO. She says that creates "a very dangerous situation for those detainees."
Deaths in detention "seem to be increasing as ICE detains more and more people with serious medical conditions," Hawkins said.
The first detained immigrant to die during the Trump administration suffered from a number of pre-existing conditions.
Roger Rayson was HIV-positive when he arrived at the LaSalle ICE Processing Center in Jena, La., after being released from a federal prison in Georgia. According to internal ICE documents, the 47-year-old citizen of Jamaica had been diagnosed with Burkitt's lymphoma, an aggressive but treatable form of cancer.
But Rayson never received chemotherapy during his time at LaSalle.
Instead, according to ICE documents, Rayson was placed in solitary confinement for nine days before being transferred to a local hospital. A little over a month later, he died at a hospital in Lafayette.
ICE's internal review of Rayson's death did not reach a conclusion on whether his care at LaSalle contributed to his death. But outside doctors who reviewed the records say his treatment was badly mismanaged, and that the government's failure to treat Rayson's cancer directly caused his death.
A spokesman for the GEO Group, which operates the LaSalle detention center, says in a written statement that health care services at the facility are provided by ICE, not GEO.
The spokesman denies that there's a "severe" outbreak, as POGO alleges. GEO provides masks for staff and detainees and "access to regular handwashing with clean water and soap," according to the spokesman. Also, the LaSalle facility has "airborne infection isolation rooms," he says.
"We take our responsibility to ensure the health and safety of all those in our care and our employees with the utmost seriousness," the spokesman said in the statement, "and we reject efforts by outside groups to advance politically-motivated agendas in the face of the unprecedented health crisis facing our country."
GEO says four of its employees at LaSalle who tested positive for coronavirus are self-quarantining, and one has recovered and returned to work.
Immigrant advocates say detainees at the facility are worried about catching it.
"People are terrified," said Laura Murchie, an attorney with the Southern Poverty Law Center who represents clients at LaSalle. "They see people with various COVID symptoms — coughing, fever, chills."
But Murchie says her clients aren't getting much health care at the facility.
"I've heard from plenty of clients that for any issue that they have, they just give you ibuprofen. And if it's not working, they just give you more," Murchie said. "They're truly endangering people's lives."
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