Immigration

Hamed Aleaziz

As an 8-year-old was dying in Border Patrol custody last month, officials at the Texas detention center where she had been held were complaining about the facility’s “overuse of hospitalization,” according to an internal report obtained by The Times.

Anadith Danay Reyes Álvarez, who suffered from sickle-cell disorder and a heart condition, had developed a 101.8 degree fever during the five days she was at the detention facility in Donna, Texas.

On May 14, two days before Department of Homeland Security investigators arrived to inspect conditions at Donna, Anadith tested positive for the flu and was transferred to a facility in Harlingen, Texas, that is designed to detain migrants with communicable diseases.

Anadith’s fever spiked to 104.9, and she was transferred May 17 to a hospital, where she died that day. A nurse at the Harlingen facility had denied Anadith’s mother’s initial requests for an ambulance or a hospital visit on the day the girl died, according to a DHS statement two weeks later. Photos of a young girl, taped in a grid onto white poster with stickers of Disney princesses, are displayed amongst flowers

Photos of Anadith Danay Reyes Alvarez are displayed during her wake last week at R.G. Ortiz Funeral Home in New York.

(Jeenah Moon / Associated Press)

Border Patrol officials’ complaints about hospitalization procedures were contained in two memos produced by the Office of the Immigration Detention Ombudsman and obtained by The Times. The relatively new oversight office is charged with reviewing conditions within Homeland Security’s vast detention system. The memos, meant for agency leadership, include details on conditions in many facilities along the southern border this spring.

The first report, dated May 15, details a spread of diarrhea among children and some overcrowding issues at a detention facility in Laredo. The second report, dated May 22, describes problems with medical care at the Donna facility.

The reports were created during a time of intense strain on the nation’s immigration detention system. Arrests at the southern border skyrocketed in the week leading up to the May 11 expiration of Title 42, the public health measure that allowed border agents to quickly turn back migrants. At one point that week, the agency was holding more than28,000 migrants in facilities at the border — way above capacity.

Both documents include a note that they reflect initial observations by the office and had not been “verified and confirmed” under the office’s typical procedures.

A third internal DHS document, dated June 8 and obtained by the Washington Post, found fault with medical care up and down the border and called for an overhaul to the system.

Homeland Security officials offered comments about the agency’s efforts to ensure detainee safety but did not provide on-the-record responses to specific questions about either of the reports The Times obtained.

According to the May 22 memo, Border Patrol officials complained about the quality of medical care at the Donna facility. The staff at Donna had a “tendency to send migrants to the hospital for things that could easily be treated on location,” the investigators wrote.

“For instance, persons with fevers are sent to the hospital instead of being given a fever-reducing medication at the facility,” they said. “The migrants typically return to Donna with ibuprofen from the hospital and no fever.”

The oversight office said that “it appears that the problems with medical care at Donna are costing CBP [U.S. Customs and Border Protection] and the main contractor … valuable staff time. CBP reported to me that they have had as many as 12 agents at the hospital at once.”

A source familiar with the report on medical care at Donna who was not authorized to speak on the record said in an email that the oversight office’s description of the Border Patrol perspective on hospitalization was “an observation that more people should be treated on the spot with the appropriate level of care as intended in the contract, rather than burdening the hospital and [Border Patrol] transport staff who are needed for more emergent cases; such as those with pre-existing conditions.”

Border Patrol officials’ complaints about the medical care at Donna were not limited to overuse of hospitalization, according to the report.

Leadership at the facility told investigators that a boy with third degree burns was treated onsite “with readily available creams when he should have been hospitalized. He later had to be sent to a burn center.”

In addition, the report noted complaints that medical staff at the facility do not “administer oxygen, even though providing oxygen is a standard EMT function.” An exterior frame of the Border Patrol station in Harlingen, Texas.

The Border Patrol station in Harlingen, Texas.

(David Pike / Valley Morning Star via Associated Press)

The report also relayed what it described as a misdiagnosis that led to “overreaction” in the facility. A nurse apparently diagnosed a person with a possible case of measles, the report said. “Fortunately, this was not an accurate diagnosis. Unfortunately, news of the diagnosis spread, and there was fear among staff and those in custody until it could be established that the information was incorrect.”

Investigators also reported that minors at Donna were “only getting checked if a problem is noted” and that “some medical staff are using Google translate on their private phones for interpreter services.”

In response, a Customs and Border Protection official said that “online translation tools are used in limited instances, and are an example of how we use every tool available to ensure communication with all those in our custody.”

CBP officials said that they are prioritizing processing families and “medically fragile” migrants and that families are spending less time in custody as a result of the review. United States Public Health Service clinicians have been deployed to border facilities to provide extra guidance and oversight, officials said.

“CBP will continue to review procedures, practices, and equipment in order to ensure that we are protecting those in our care,” a spokesperson said in a statement.

Border detention facilities are not prepared to handle the complex issues they face, Parmar said.

“These have become health systems without the resources to be health systems,” she said. “The system doesn’t have what they need to take care of complex patients … there should be a comprehensive review of cases, charts, and external oversight to determine what could strengthen the system.”

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Diarrhea was rampant, children were losing weight, and parents had to clean soiled clothing in sinks because guards would not provide them with clean items, mothers at an overcrowded Texas border facility in Laredo told Department of Homeland Security investigators last month, according to an internal report obtained by The Times.

The crisis at the Laredo facility is detailed in the first of two May memos by the Office of the Immigration Detention Ombudsman. The relatively new oversight office is charged with reviewing conditions within DHS’ vast detention system. The memos, meant for agency leadership, include details on conditions in many facilities along the southern border this spring.

The second report, which was also obtained by The Times, describes alleged deficiencies in medical care at a detention facility in Donna, Texas, that held an 8-year-old Panamanian girl who later died in Border Patrol custody.

Both documents include a note that they reflect initial observations by the office and had not been “verified and confirmed” under the office’s typical procedures.

Nearly every mother at Laredo who spoke to the investigators said their children had diarrhea.

“Some women noted that their children had not eaten much, if at all,” the investigators — who visited the facility between May 9 and May 11, wrote. “Others noted that their children had lost weight.”

Some mothers whose children were affected said they believed the diarrhea was the result of being given too much dairy and processed food at the facility.

The investigators told Border Patrol about the detainees’ complaints, and the second report said that the diarrhea issue at Laredo had been resolved.

The report also detailed overcrowding.

The memo noted that the Laredo facility was holding about 2,500 people — despite having a capacity of under1,000 — and that some housing areas for single men were “very cramped, with sleeping mats directly touching other sleeping mats and no space around the mats to walk.”

Even so, the memo, said the facility was “airy, open, and clean, and felt calm and orderly.”

Homeland Security officials offered comments about the agency’s efforts to ensure detainee safety but did not provide on-the-record responses to specific questions about either of the reports The Times obtained.

Border Patrol conditions have long been scrutinized. During the Trump administration, the DHS Inspector General’s Office conducted an investigation that found in several facilities migrants in cramped spaces — some were in standing-room conditions for a week — and not having access to showers. The inspectors called it dangerous.

“Senior managers at several facilities raised security concerns for their agents and the detainees. For example, one called the situation “a ticking time bomb,’” the report read.

In 2021, when an increase in unaccompanied immigrant children crossing the border led to overcrowding in border patrol facilities, attorneys for the children said the conditions were cramped after conducting interviews with them, according to the Associated Press. The attorneys said they were unable to visit the facilities themselves.

A special monitor overseeing the medical care in border facilities said in a January report to a federal court that improvements were being made to medical care within the facilities and that caregivers were being added to some places. The monitor’s reports are part of a years-long court settlement that requires the government to not hold children and families longer than 72 hours in custody.

The monitor wrote that areas of improvement included the care of unaccompanied children “in isolation stations” and “regular overcrowding of CBP facilities represents the most far-reaching threat to compliance with the agreement and to the provision of essential custodial services for children. It also underscores CBP’s responsibility to address overcrowding and mitigate its impact on children in custody.”

Conditions within border facilities attracted scrutiny after the 8-year-old girl died in custody on May 17. CBP officials released a statement that said a nurse at the agency’s Harlingen Station denied requests from the girl’s mother to send her to the hospital or call an ambulance three or four times. The girl’s mother told the Associated Press that: “I felt like they didn’t believe me.”

The numbers of border arrests have dropped in the weeks since Title 42 expired. In early June, DHS said that the number of border crossings had dropped 70% from the high arrest numbers seen in early May.

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