Weaknesses in Customs and Border Protection policies, procedures, and oversight — along with training gaps — have left agents and officers challenged in spotting detainees who could be having medical emergencies and ensuring they receive needed care, according to an oversight report.
The Office of Inspector General conducted the audit per a March 2020 request from Congress, after a 2019 OIG review that found no DHS misconduct or malfeasance in the deaths of two children in CBP custody.
From November 2019 to April 2020, CBP reported 171,937 apprehensions and 28 deaths at the southwest border with five of those deaths occurring in CBP custody.
The medical screening process begins when agents first encounter a migrant. Agents and officers are trained to observe whether the person may have a health issue, or the migrant might self-report a health concern. Individuals may be referred to a health interview, in which personnel document health concerns of the migrant in custody. Health interviews are also conducted on detainees under the age of 18.
Children 12 years of age or younger, along with any person reporting a medical concern, receive an assessment from medical personnel. As of July 2020, 67 Border Patrol stations and field offices along the southwest border had contracted medical support. If the medical issue is beyond the capabilities of staff — such as necessary X-rays or surgical procedures — then migrants are taken to a local medical facility for evaluation and treatment.
“CBP has improved its medical program by creating new policies and expanding contract medical personnel,” OIG reported. “However, CBP personnel did not always provide evidence to demonstrate staff performed required health interviews and did not ensure medical staff always conducted medical assessments, nor could CBP demonstrate personnel consistently conducted regular welfare checks of individuals in custody.”
“This occurred because CBP lacks sufficient oversight and clear policies and procedures or did not ensure officers and agents were adequately trained to identify the need for medical attention,” the report added. “As a result, CBP may not identify individuals experiencing medical emergencies and may not provide appropriate care to these individuals.”
CBP’s records for 98 people reviewed by OIG “could not demonstrate health interviews and medical assessments were conducted,” including health interviews and medical assessments for 13 of 15 individuals age 12 or younger, health interviews for 16 of 28 individuals ages 13 to 17, and medical assessments for 4 of 9 individuals referred for an assessment.
“This occurred because CBP headquarters did not provide the oversight needed to ensure officers and agents followed policy,” OIG found. “CBP’s Enhanced Medical Support Efforts directive requires Border Patrol and OFO to develop an appropriate Medical Quality Management program to oversee the medical care of individuals in CBP’s custody. However, CBP has not yet fully implemented the program. According to officials, CBP is still in the process of developing the oversight portion of its Medical Quality Management program, which will include monitoring compliance with medical screening policies. Additionally, CBP’s Management Inspections Division plans to incorporate enhanced medical reviews and inspections into its Self-Inspection Program.”
OIG also found that CBP staff did not consistently conduct welfare checks on detainees. In the sample of 98 individuals used by auditors, 35 were checked within every hour, 44 were checked every 1-4 hours, 5 were checked after 4 hours and varied intervals thereafter, 5 were not checked at all, and 9 were not checked because they were released quickly after being detained.
OIG said it found nine “at-risk” individuals — those with a known or reported contagious disease, illness, and/or injury — who did not receive welfare checks every 15 minutes as required. This was attributed to “inadequate guidance” on welfare checks.
“In one example, a female suffering from a fractured pelvis received welfare checks hourly instead of at the required 15-minute intervals,” OIG wrote. “Welfare checks are critical to safeguarding individuals to ensure they are not experiencing medical emergencies or other serious health conditions in CBP’s custody.”
CBP also lacks guidance to help agents and officers recognize symptoms that may indicate an “at-risk” individual, such as coughing or difficulty breathing, red or flushed cheeks, or lethargy. “Further, once a detained individual has been determined to be at-risk, CBP policy does not require agents and officers to use their system of record to alert other personnel about the individual’s status,” the report added. Additionally, with COVID-19 symptoms that may not appear until days after exposure, “recurring medical screening would help safeguard individuals by helping to detect symptoms that may arise after they are initially screened, especially during longer detention periods.”
OIG also noted that CBP “could better identify those who may be ill and prevent deaths” by conducting medical assessments on all children under 18 years of age.
“Without adequate training, CBP agents and officers may not recognize and be able to respond to emergency medical issues either at initial encounter or while in custody,” OIG wrote. “By improving its medical guidance and strengthening its oversight and training to ensure compliance with policies and procedures, CBP could better mitigate the risk of serious illness and death of people in its custody.”
OIG recommended that the CBP acting commissioner “periodically assess and document requirements to review and update related policies and procedures to clearly define at-risk populations, establish set times for frequency of welfare checks, ensure completion of medical assessments for all juveniles, and ensure rescreening of migrants after detainment exceeds guidelines.” CBP said it will assess policies and make changes as needed by Feb. 28, 2022.
By that date, CBP also “plans to continue to work with the Management Inspections Division to review and update Self-Inspections Program worksheets associated with medical screening, welfare checks, and recording supporting documentation.” And the agency also “was developing a training presentation to help non-medical personnel recognize medically distressed adults and juveniles in CBP custody.”