Doctors: Deaths of 2 migrant kids preventable
More medical training needed, experts testify
Two doctors told members of Congress that the deaths of two migrant children in the custody of Border Patrol agents at the U.S.-Mexico border could have been prevented if agents had more medical training and if migrants in U.S. custody had improved access to adequate care.
The House Committee on Homeland Security held a virtual hearing on Wednesday to address the deaths of two Guatemalan children in December 2018 — the first deaths of minors in custody in nearly a decade.
They also scrutinized Border Patrol’s medical procedures for migrant children in its custody.
Seven-year-old Jakelin Caal Maquin and eight-year-old Felipe Gomez Alonzo died about two weeks apart after crossing the border illegally with their fathers and turning themselves in to border agents in New Mexico. The two spent several days in Border Patrol custody, during which their conditions worsened and required hospitalization.
“Review of available records makes clear that Jakelin and Felipe both suffered terrifying and painful deaths that could potentially have been prevented by timely access to pediatric medical care,” said Fiona Danaher, a pediatrician at Massachusetts General Hospital.
Jakelin died on Dec. 8, 2018 of septic shock, leading to multiple organ failure. Felipe died two weeks later, on Christmas Eve, from bacterial pneumonia coupled with a diagnosed, but untreated, flu infection.
The Office of the Inspector General — the watchdog body for the U.S. Department of Homeland Security, which includes Border Patrol — found no evidence of misconduct or malfeasance from border agents in either case.
Joseph Cuffari, the inspector general, said their investigations determined in both cases that border agents “exhibited great concern for the children’s welfare and obtained medical treatment without delay,” he said.
But the two medical experts that the committee tasked with conducting independent investigations of the cases testified that the medical procedures that agents followed were inadequate and spoke of “irregularities” in the care the children received.
“Immediate and timely access by licensed, trained medical professionals could have prevented the deaths of both Jakelin and Felipe,” said Roger Mitchell, the medical examiner for the District of Columbia. “The deaths of both these two children are symptoms of a more extensive system that requires much improvement.”
Since Jakelin and Felipe’s deaths in December 2018, four other minors have died while in Border Patrol custody.
Wednesday’s hearing also covered the reported misuse of nearly $17 million that Congress had allocated to U.S. Customs and Border Protection to care for a surge of migrant families and minors that overwhelmed the agency in the first half of 2019.
Lawmakers designated $112 million as part of emergency funding bill to the border agency for the medical care of migrants in custody and other consumable items, such as baby formula, masks and gloves.
Instead, CBP used part of the money, totaling almost $17 million, to pay for supplies for its canine agents, dirt bikes, office equipment such as printers and facility upgrades, among other things, according to an audit by the U.S. Government Accountability Office, a congressional watchdog office.
The GAO published a more detailed report on Wednesday with their findings and called for greater oversight and accountability for Customs and Border Protection. The agency agreed with their recommendations and issued guidance on how to address them. CBP also said they would adjust their accounts to properly allocate any misused funds.
CBP head skipped hearing to comply with White House rules
Wednesday’s hearing included some expected partisan back and forth among lawmakers sitting on the House committee about the purpose of the hearing and ultimately who’s responsible for migrant deaths.
While Democrats pushed for greater accountability for Customs and Border Protection, Republicans said cartels and smugglers were to blame.
At the heart of the issue is what happens after border agents apprehend migrant children. By law, border agents can legally hold children for up to 72 hours. But the surge in 2019 meant kids and their parents spent longer times in their custody.
Following Jakelin and Felipe’s deaths, CBP issued a directive requiring medical screenings for all minors. The final version reduced that requirement to minors under the age of 12.
But critics said the agency is inconsistent with those policies, citing reports and testimony from the Inspector General which found that medical care varies by facility and what they have available at the time.
Mitchell and Danaher said they’d like to see more medical training for any border agent who interacts with children while in custody, as well as having trained medical professionals on site to screen children in a “timely fashion” and identify if any of them are sick before more serious complications arise.
That prompted push back from U.S. Rep. Mark Green, R-Tenn., a physician and former combat surgeon. Nearly all the Republicans present for the hearing yielded most, if not all of their time to allow him to question the four witnesses.
“Where in the world are we gonna get doctors to put somebody at every single
crossing site?” he said, citing a nationwide doctor shortage. “This testimony proposes building health care infrastructure for illegal immigrants that would dwarf the health care systems of 77% of rural counties in America.”
Several Democrats criticized Green’s comments, saying they pitted people against each other, rather than focusing on solutions.
Danaher and Mitchell also responded saying the medical workers did not have to be doctors but could also be paramedics or nurse practitioners, so long as they had medical training.
One notable voice missing at hearing was Customs and Border Protection Acting Commissioner Mark Morgan. In a letter to the committee, he explained his decision not to testify because of White House rules barring him from appearing for virtual hearings.
U.S. Rep. Bennie Thompson, D-Miss., the committee chairman, chastised that decision.
He said documents the Department of Homeland Security provided in response to a subpoena were “incomplete,” and full of “extensive and improper redactions.” In other instances, they didn’t provide the committee documents cited in oversight reports, he added.
“Through its refusal to comply fully with the Committee’s subpoena, and through its many redactions, the department is intentionally impeding the committee’s investigation,” Thompson said.
No medical professionals were involved in DHS investigations
Democrats reserved some of the heaviest scrutiny for Cuffari, the inspector general for the Department of Homeland Security. His office conducted the investigations following Jakelin and Felipe’s deaths that cleared agents of any misconduct or malfeasance.
Several lawmakers questioned the methods investigators used to arrive at those conclusions, saying they did not review key pieces of evidence and documents tied to their deaths.
Cuffari said they conducted 44 interviews as part of their investigations. But he admitted that they didn’t have any medical professionals, such as forensic experts, on staff at his office to review and analyze the information they gathered.
“Based on increased funding ... that the House an Senate gave us this year, we were able to seek outside medical contracts,” he said. “I anticipate that by the end of the next month the individual health care providers will be able to augment our inspectors and investigators and the auditors.”
Cuffari also told U.S. Rep. Xochitl Torres Small, D-N.M. — whose district spans southern New Mexico, including the areas where agents apprehended Jakelin and Felipe — that they would not have medical expertise available for a third investigation of another child’s incustody death that is nearly finished.
But he added that his office has 20 ongoing projects that will look into the care of migrant children in the custody of the U.S. government, including one about prolonged detention and a review of Border Patrol’s “handling of medical health care providers and services to in custody children,” he testified.
GAO: CBP not consistently following medical directives
An 88-page report the Government Accountability Office, published on Wednesday at the committee’s request, found that Customs and Border Protection facilities along the U.S.-Mexico border “were not consistently conducting health interviews and medical assessments, as required by the medical directives.”
The GAO also found that CBP was not consistent in providing all of its border officers and agents with training, even though they require them to monitor children in custody for signs of medical distress.
In addition, the report noted that CBP decided not to follow a recommendation from the U.S. Centers for Disease Control and Prevention to offer flu vaccines to migrants in its custody.
“CBP identified to us a number of challenges to offering those vaccines, including things like providing cold storage and the need for increased contracted medical care providers,” said Rebecca Gambler, the director for the GAO’s Homeland Security and Justice team.
“But they didn’t document how they considered or weighed those costs, or considered those costs versus the benefits that could come from offering the influenza vaccine,” she added.
CBP officials also told investigators they found little benefit in providing the flu vaccine to migrants in custody “given that it is CBP’s goal to transfer individuals out of their custody within 72 hours, while the influenza vaccine takes 14 days to take effect,” according to the report.
However, the GAO noted issues with overcrowding at a number of CBP facilities last year, which resulted in lengthier times in custody for migrants.
The watchdog office included a list of 10 recommendations to strengthen oversight of the agency’s medical procedures, as well to properly document and report information on deaths, injuries and suicide attempts.
As part of their report, GAO found that 31 people died in CBP custody from 2014 to 2019. However, the agency documented only 20 deaths in their reports.
In their response to the recommendations, Customs and Border Protections said they would review and update their procedures to comply with the recommendations. They set the target date to complete all 10 recommendations by February 2021.