Durbin Leads Release Of GAO Report Recommending Improved Oversight Of Medical Care In CPB Custody

Durbin Leads Release Of GAO Report Recommending Improved Oversight Of Medical Care In CPB Custody

Lawmakers requested this report after a CBP whistleblower came forward alleging deficient medical care and oversight, as well as the death of an 8-year-old girl in custody

WASHINGTON - U.S. Senate Democratic Whip Dick Durbin (D-IL), Ranking Member of the Senate Judiciary Committee, led a group of colleagues in releasing the Government Accountability Office's (GAO) newly-completed report on systemic failures at U.S. Customs and Border Protection (CBP) that resulted in years of deficient medical care.

The report was requested in December 2023 after the death of Anadith Danay Reyes Álvarez, an eight-year-old girl with sickle cell and congenital heart disease who died in CBP custody in Harlingen, Texas. The request also followed a CBP employee whistleblower disclosure alleging years of deficient medical care at CBP facilities and CBP's failure to ensure proper oversight of that care. Since then, public reporting shows a system that is fragmented, under-supervised, and increasingly unsafe, especially as the Trump Administration continues its unpopular anti-immigrant agenda. The same contractor for medical services at issue in the CBP medical care investigation has the contract for medical services at Camp East Montana, a facility cited for violating medical care standards where several individuals have recently died.

The report, entitled "Southwest Border: CBP Should Improve Oversight of Medical Care for Individuals in Custody," lays out how CBP has failed to ensure medically vulnerable individuals receive required care while in its custody, despite current policies in place. GAO found that although CBP adopted new measures following the May 2023 death of Anadith Danay Reyes Álvarez, the agency did not adequately monitor whether those policies were followed. GAO documented widespread failures to provide required medical assessments and monitoring for pregnant individuals, sick or injured adults, and other high-risk people, concluding that CBP lacks effective oversight to enforce its own medical standards. The report also found that vulnerable individuals are not consistently prioritized for expedited processing and are often held beyond 72 hours and that DHS has refused to establish clear criteria for who qualifies for quicker processing. In addition, GAO found that CBP has mismanaged its medical services contracts, leaving the agency unable to ensure adequate care or hold contractors accountable.

"The situation has long been dire for those in immigration detention. But with the onset of President Trump's unpopular, inhumane anti-immigrant agenda, the urgency to reform oversight of medical care in CBP facilities is even more pressing. When human beings are in the government's custody, we are responsible for ensuring they receive proper care. I urge CBP to aggressively implement these reforms and for Republicans in Congress to join Democrats in ensuring robust oversight of immigration detention facilities," said Durbin.

In addition to Durbin, the report was requested by U.S. Representatives Bennie Thompson (D-MS-02), Robert Garcia (D-CA-42), Jamie Raskin (D-MD-08), Alexandria Ocasio Cortez (D-NY-14), and Teresa Leger Fernández (D-NM-03).

"CBP's persistent failure to provide basic care for the men, women, and children in its custody is unconscionable and incompatible with our nation's laws and values. The findings detailed in this report are profoundly troubling. At a moment when the Trump Administration has dramatically intensified its extreme and deadly immigration enforcement tactics, Congress has an urgent and bipartisan obligation to exercise robust oversight of immigration detention facilities and ensure that fundamental standards of humanity and due process are being upheld," said Raskin.

"The Democratic Women's Caucus has sounded the alarm for months on the egregious mistreatment of women in Customs and Border Protection (CBP) and Immigration and Customs Enforcement (ICE) custody. The murder of Renee Good by an ICE agent and the deportation of an eight-months-pregnant woman in medical distress this week are just a couple recent examples of their complete disregard for human life. CBP leaves pregnant women without critical medical exams, withholds prescriptions and medical records from individuals in their care, and neglects to follow its own procedures and care requirements. These offenses are inhumane, completely unacceptable, and should offend every American. We demand CBP immediately reform how they care for women in custody," said Fernández.

The report made fourteen recommendations, of which CBP agreed to thirteen:

• The CBP Commissioner should ensure that the Office of the Chief Medical Officer takes action, such as providing additional training or guidance, to ensure contracted medical personnel understand the difference between medical assessments and medical encounters, and reasons for the difference.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer develops and implements an oversight mechanism to ensure individuals receive required medical assessments.
• The CBP Commissioner should clearly document in policy or guidance the factors that CBP personnel should consider to determine an individual in custody is at-risk based on serious physical or mental injuries or illnesses for the purpose of expeditious processing under CBP's standards for short-term custody.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer develops and implements an oversight mechanism for CBP and contracted medical personnel to ensure medically high-risk individuals in custody receive required medical care, including medical monitoring checks and red wristbands.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer includes information in monitoring reports on individuals at facilities without contracted medical personnel to ensure they receive the medical care required under CBP guidance.
• The CBP Commissioner should develop and implement a mechanism to ensure that individuals who had medical issues identified or addressed while in CBP custody have their medical summary forms any time they leave custody.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer and the Office of Acquisition specify in any future medical services contracts, including bridge contracts, the minimum staffing level that CBP needs from the contractor.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer and the Office of Acquisition establish a performance target in any future medical services contracts, including bridge contracts, to measure whether the medical services contractor is meeting minimum staffing levels.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer performs a cost-benefit analysis of the medical services contract's scope of practice and staffing levels to compare the costs of providing nonemergency care through contracted medical personnel at CBP facilities to the costs of providing that care at a hospital or other local health system location and documents any resulting cost savings.
• The CBP Commissioner should ensure that the Office of Acquisition conducts a lessons learned analysis on how it administered its medical services contracts, to include identifying and analyzing risk areas and applying corrective actions.
• The CBP Commissioner should ensure that the Office of Acquisition, in coordination with the Office of the Chief Medical Officer, develops a contract administration plan for any future medical services contracts, including bridge contracts, to include roles and responsibilities and performance metrics.
• The CBP Commissioner should ensure that task order monitors or their equivalents supporting any future medical services contracts, including bridge contracts, are certified at the same level as the primary contracting officer's representatives and appointed by the contracting officer.
• The CBP Commissioner should ensure that the Office of Acquisition complies with the timing requirements to submit contractor past performance evaluations for any future medical services contracts at least annually and also at the end of the period of performance, consistent with the Federal Acquisition Regulation.
• The CBP Commissioner should ensure that the Office of the Chief Medical Officer updates existing guidance that includes clear responsibilities for the Office of the Chief Medical Officer Medical Quality Division, including responsibilities to fully document action plans and track corrective actions for the quality assurance and sentinel event review elements of the MQM program.

Notably, CBP did not agree to the recommendation to clearly document in policy or guidance the factors that CBP personnel should consider to determine an individual in custody is at-risk based on serious physical or mental injuries or illnesses for the purpose of expeditious processing under CBP's standards for short-term custody, despite the Senate Judiciary Committee making a similar recommendation.

For a copy of the GAO report, click here.

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