March 04, 2020

Warren, Velázquez Sound Alarm Over Customs and Border Protection's Deficient Medical Directive for Screening and Delivery of Medical Care to Migrants

New Medical Directive "Wholly Inadequate" to Ensure Proper Care of Migrants, Weaker Than Policy it Replaced

Text of Letter (PDF)

Washington, D.C. - United States Senator Elizabeth Warren (D-Mass.) and Representative Nydia M. Velázquez (D-N.Y.) sent a letter to Mark Morgan, Acting Commissioner of U.S. Customs and Border Protection (CBP), calling on CBP to strengthen its new Medical Directive, which mandates the agency's requirements for medical screening and delivery of medical care to migrants in CBP custody.

"We, along with other Members of Congress, have repeatedly called on CBP to improve its already deficient and unconscionable approach to medical care for migrants," the lawmakers wrote. "But according to medical professionals, the new policy governing CBP's delivery of medical care 'represents a step in the wrong direction as compared to the Interim Medical Directive' that it replaced, and is 'wholly inadequate to ensure the proper care' of migrants in CBP custody."

In their letter, the lawmakers outlined three major concerns with the Medical Directive, which the CBP issued in December 2019 to direct the agency's "deployment of enhanced medical efforts to mitigate risk to, and improve care for, individuals in CBP custody along the Southwest Border": (1) that the Medical Directive's screening protocol is inadequate, and is inconsistent with recommendations made by the Centers for Disease Control and Prevention (CDC) and the Homeland Security Advisory Council (HSAC); (2) that the directive is weaker than the policy it replaced, including by eliminating a requirement that all children under age 18 receive a health assessment, and by diluting current requirements for what constitutes a health assessment and who can conduct them; and (3) that the Medical Directive lacks crucial requirements for ongoing medical care beyond an initial screening.

"We urge CBP to strengthen its Medical Directive through its implementation plan and we are seeking answers about why you have not elected to instate a stronger Directive that prioritizes migrant health," the lawmakers continued.

The lawmakers urged CBP to remedy the Directive's deficiencies in its implementation plan by addressing the following:

  • Establishing clear policies for how CBP personnel should handle the provision and management of prescription medications for migrants arriving at the border;
  • Outlining specific measures for addressing the flu and mitigating the conditions that contribute to the spread of other infectious diseases-including incorporating recommendations made by the HSAC and CDC into its implementation plan;
  • Including provisions for addressing linguistic and cultural barriers faced by migrants, including guaranteeing language translators and assistance for individuals who may be illiterate;
  • Adding guidelines for ensuring that the mental health concerns of migrants are appropriately screened and addressed;
  • Specifying that children detained at the border will receive care from medical personnel with specific pediatric training; and
  • Setting required timeframes for conducting medical screenings.

The lawmakers also asked CBP to respond to a series of questions about the implementation of its Medical Directive by March 17, 2020.

The letter is part of Senator Warren's ongoing efforts to protect the health and safety of immigrants and asylum seekers through Senate oversight:

  • In September 2019, Senator Warren expressed serious concerns over the Department of Homeland Security's (DHS) announcement that migrant families currently detained at CBP holding centers would not be vaccinated for the flu ahead of the flu season. She and Representative Rosa DeLauro (D-Conn.) followed up with another letter in December 2019 calling on the agency to provide vaccinations.
  • Senator Warren sent a letter to DHS after reports of the death of a child in CBP's custody. She followed up on these concerns after the death of five children in custody in the span of six months. She also joined Senator Brian Schatz (D-Hawai'i) and seven other senators calling for the federal government to investigate federal contractors after disturbing reports of hungry, sick, and unbathed children being held in federal contractor facilities near the border were made public. She wrote to CBP requesting answers on steps being taken to protect children and called for the Homestead Temporary Shelter for Unaccompanied Children to be shut down. 
  • In January 2020, Senator Warren joined a congressional amicus brief urging the Ninth Circuit to uphold the Flores Settlement Agreement, which provides safeguards for children in immigration detention. In September 2018, she joined Senator Durbin and her senate colleagues on a letter DHS and the Department of Health and Human Services, opposing the proposed rollback of the Agreement.
  • In February 2020, Senators Warren and Robert Menendez (D-N.J.) and 19 of their Senate colleagues wrote to Secretary of State Mike Pompeo, Attorney General William Barr, and Acting Secretary of Homeland Security Chad Wolf raising concerns about the legality of three international "asylum cooperative agreements" used by the Trump Administration to expel asylum seekers to Northern Triangle countries.
  • Following a DHS Inspector General (IG) report regarding unsafe conditions and mistreatment of immigrants at a number of privately-run immigration detention centers, Senator Warren opened investigations into two of the country's largest private prison contractors and the contractor responsible for auditing detention facilities. She released findings that revealed that none of the companies had taken responsibility for egregious failures identified by the DHS IG and demonstrated an ongoing dispute between the auditor and the IG about the quality of the auditor's inspections. 
  • In October 2019, Senator Warren sent a letter to the DHS's Office for Civil Rights and Civil Liberties (CRCL) requesting information regarding CRCL's oversight of U.S. Immigrations and Customs Enforcement (ICE) detention facilities and ICE's reported misuse of solitary confinement at those facilities. She also requested an investigation into reports of solitary confinement being used to coerce participation in "voluntary" work programs at immigration detention facilities.
  • Also in November 2019, Senator Warren joined Senator Jeff Merkley (D-Ore.) in requesting the public release of a DHS report detailing the flaws in the Remain in Mexico program.
  • Last year Senator Warren joined Ranking Member Menendez and colleagues in calling on the Trump Administration to end the Remain in Mexico program.
  • Senator Warren and Senator Tammy Baldwin (D-Wisc.) wrote to DHS, ICE, and CBP last year, citing reports of abuse and neglect of transgender migrants and asylum seekers, and urging the Trump Administration to reverse policies-including misuse of solitary confinement-that are harming these vulnerable populations.
  • In May 2019, the senator opened an investigation into the accreditation process for private detention operators following widespread reports of mismanagement and poor conditions for detainees in facilities nationwide.
  • In August 2019, Senators Warren and Ed Markey (D-Mass.) and Representative Ayanna Pressley (D-Mass.) led more than 100 of their colleagues in a letter to DHS, ICE, and U.S. Citizenship and Immigration Services (USCIS),objecting to the decision to end consideration of non-military deferred action requests-a decision that would affect individuals seeking medical deferments for life-saving treatments. USCIS reversed their decision after this congressional action.