Medical Care Standards in Immigrant Detention Facilities
April 2, 2024
Medical Care Standards in Immigrant Detention Facilities
In recent years, the COVID-19 pandemic and whistleblower
developed in 2008, the updated 2011 PBNDS were revised
complaints about medical neglect and unnecessary
in 2016 to meet detention standards consistent with federal
gynecological procedures have led to concerns over the
legal and regulatory requirements as well as ICE policies
medical care of noncitizens in the custody of Immigration
and policy statements. Improvements to medical and mental
and Customs Enforcement (ICE). This In Focus provides
health services were a significant part of the revision.
background on Immigrant Detention Facility medical care
(Although it was revised in 2016, the standards are still
standards, medical care delivery, and the oversight of ICE
referred to as the 2011 PBNDS.) Some facilities still adhere
detention facilities.
to the 2008 PBNDS. These facilities hold 10% of the
detained immigrant population. The National Detention
ICE’s Enforcement and Removal Operations (ERO) is
Standards (NDS) 2000/2019 are applied at facilities that
responsible for immigration enforcement in the interior of
house 22% of all detainees. The revised 2011 PBNDS are
the United States, including managing and overseeing the
considered to be the highest-quality set of detention
immigrant detention system. Federal law provides ICE with
standards and ICE aims to implement them in the one-third
broad authority to detain noncitizens while awaiting a
of facilities not currently using them.
determination of whether they should be removed from the
United States, and describes certain categories of
Medical Care Standards
noncitizens who are subject to mandatory detention (e.g.,
Under all three standards, the services that are required to
when the noncitizen is removable on account of certain
be provided directly or contractually to detainees include
criminal or terrorist activity) (8 U.S.C. §§1225, 1226,
• initial medical, dental, and mental health screenings;
1226a, 1231, and 1357). Federal law also provides authority
for medical care for those in immigration detention (42
• routine and preventive care, specialty care, emergency
U.S.C. §§249 and 34.7(a)).
care, and hospitalization, as medically indicated;
ICE Detention Facilities
• timely responses to medical complaints; and
Some detention facilities exclusively house adult ICE
detainees (dedicated facilities) while others are state or
• language services when needed during any appointment,
local facilities or privately run facilities that house both
treatment, or consultation.
state or local inmates as well as ICE detainees (non-
dedicated facilities). ICE owns and operates some of its
The 2011 PBNDS also include an array of protocols for
own facilities; others are owned and operated by private
staff, such as notifying detainees of health care services and
companies or state or local governments, which have
guidance on informed consent and involuntary treatment. In
contracts or intergovernmental agreements, respectively,
addition, the 2011 PBNDS include a section dedicated to
with ICE. Generally, facilities housing adult immigrant
medical care specifically for women, including routine
detainees must comply with one of several sets of ICE
gynecological and obstetrical healthcare, and consideration
detention standards.
of requests to be seen by a same-gender healthcare
Detention Standards
provider. In July 2021, ICE announced a new directive that
specifies that immigrants who are pregnant, nursing, or
ICE detention standards cover a wide range of areas related
postpartum will not be detained while they wait for
to safety, security, order, care (including medical care),
immigration court proceedings, unless they are subject to
activities (such as visitation), justice (such as a grievance
mandatory detention.
system), and the administration and management of
facilities.
Delivery of Medical Care
All detained immigrants’ healthcare falls under the
Generally, three sets of standards are applied at facilities
authority of the ICE Health Services Corps (IHSC).
that house the detained adult immigrant population. (There
According to IHSC, in FY2023 just over 40% of those in
are other standards for specific types of immigration
ICE custody received direct services from the IHSC for
detention facilities, such as family detention centers and
routine care. In non-IHSC staffed facilities, local
facilities under contract with the U.S. Marshals Service,
government staff or private contractors provide similar
which are outside the scope of this In Focus.) Contracts or
services, with oversight by IHSC.
agreements between ICE and the detention facility
determine the standards to which the facility is required to
Each facility has a health service administrator who is
adhere. The 2011 Performance-Based National Detention
responsible for overall health care services within facilities.
Standards (PBNDS) are applied at dedicated facilities that
Every facility also has a designated clinical medical
house 68% of the detained immigrant population. First
authority (CMA) who is a doctor (MD or DO) responsible
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Medical Care Standards in Immigrant Detention Facilities
for overall medical clinical care, and may designate a
Self-Assessments
clinically trained professional to have authority if they are
Facilities with an immigrant detainee ADP under 10
not available. In addition, each facility has a facility
conduct annual self-assessments against the NDS 2000
administrator who negotiates arrangements with nearby
standards. For all self-identified deficiencies, the facility
medical facilities to provide care unavailable at the facility
must work with the ERO field office and ICE Custody
and transportation for offsite care.
Management to develop a corrective action plan.
Detention Monitoring Program
All facilities that house ICE detainees for more than 72-
The detention monitoring program, overseen by ICE
hours are required to have some type of onsite clinical
Custody Management, was established in 2010. As of
setting for examinations and treatment of routine
December 2019, there were 39 Detention Service Managers
conditions, though they vary in terms of the levels of care
(DSMs) at 54 detention facilities, covering 67% of the ADP
they are capable of delivering. Offsite emergency room
of immigrant detainees. DSMs continuously monitor
visits and care by specialists must be approved by the
detention facilities for compliance, working with the facility
IHSC.
directly to resolve any deficiencies. However, DSMs do not
Detention Standards Oversight
have the authority to require these corrective actions. Their
effectiveness often relies on their personal relationships
ICE employs a multifaceted, layered approach to oversight
with facility staff and support of ERO field officers.
of detention facilities. The inspections are conducted by
different entities depending on the size and type of facility.
Reports on Compliance Challenges
In addition, ICE deploys a detention monitoring program.
There are multiple DHS OIG and GAO reports that indicate
ICE Contractor Inspections
inadequate compliance with detention standards; some
focus specifically on health care issues. For example, see
An ICE contractor, the Nakamoto Group, provides the most
frequent inspections of the larger ICE detention facilities. It
• GAO, Immigrant Detention: Additional Actions Needed
conducts annual inspections of facilities that have an
to Strengthen Management and Oversight of Detainee
Average Daily Population (ADP) of immigrant detainees
Medical Care, GAO-16-321, February 2016;
over 50 and hold individuals for over 72 hours. It evaluates
• DHS OIG, Concerns about ICE Detainee Treatment and
approximately 100 facilities a year on 42 or 39 detention
Care at Detention Facilities, OIG-18-32, December 11,
standards (depending on whether the facility operates under
2017;
PBNDS or NDS), comprised of over 650 components. It
• DHS OIG, ICE Does Not Fully Use Contracting Tools
also completes an additional Quality of Medical Care
to Hold Detention Facility Contractors Accountable for
Assessment.
Failing to Meet Performance Standards, OIG-19-18,
January 29, 2018;
Multiple government agencies (e.g., U.S. Department of
• DHS OIG, ICE’s Inspections and Monitoring of
Homeland Security [DHS] Office of Inspector General
Detention Facilities Do Not Lead to Sustained
[OIG] and the Government Accountability Office [GAO])
Compliance or Systemic Improvements, OIG-18-67,
have criticized Nakamoto inspections. For example, the
June 26, 2018;
DHS OIG found Nakamoto to have inconsistent inspection
• DHS OIG, Concerns about ICE Detainee Treatment and
practices and inadequate interviews with detainees (e.g., not
Care at Four Detention Facilities, OIG-19-47, June 3,
conducted in private, very brief, only interviewing English
2019;
speakers, utilizing facility staff as translators). Nakamoto
• GAO, Immigrant Detention: Care of Pregnant Women
was found to rely on written policies and procedures or
in DHS Facilities, GAO-20-330, March 2020;
brief staff answers rather than observing and evaluating
• DHS OIG, Capping Report: Observations of
facility conditions itself. Moreover, inaccuracies were
Unannounced Inspections of ICE Facilities in 2019,
found in its post-inspection reporting to ERO. The OIG
OIG-20-45, July 1, 2020;
concluded that Nakamoto inspections are too broad and
• GAO, Immigrant Detention: ICE Should Enhance Its
they cannot reasonably cover 650 elements in three days
Use of Facility Oversight Data and Management of
using a small number of inspectors. Also, inspections are
Detainee Complaints, GAO-20-596, August 2020;
preannounced, allowing facilities the opportunity to make
• DHS OIG, Medical Processes and Communication
temporary changes in order to pass the inspection.
Protocols Need Improvement at Irwin County Detention
Center, OIG-22-14, January 3, 2022;
Office of Detention Oversight Inspections
• GAO, Immigrant Detention: ICE Needs to Strengthen
ICE’s Office of Detention Oversight (ODO) inspects over
Oversight of Informed Consent for Medical Care, GAO
72-hour facilities with an immigrant detainee ADP of more
-23-105196, October 2022;
than 10. These inspections, which occur once every three
• GAO, Immigration Detention: ICE Can Improve
years, are more in-depth than contractor inspections.
Oversight and Management, GAO-23-106350, January
However, they only evaluate 15 or 16 core standards
2023; and
(depending on which set of standards the facility adheres
• DHS OIG, ICE and CBP Deaths in Custody during FY
to). These inspections are praised by DHS OIG for being
2021, OIG-23-12, February 1, 2023.
more thorough on the factors they review, albeit less
comprehensive; but they are also criticized for only being
Abigail F. Kolker, Analyst in Immigration Policy
performed every three years. As with contractor
inspections, ODO inspections are preannounced.
IF12623
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Medical Care Standards in Immigrant Detention Facilities
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