The Office of Inspector General has assessed the causes and impact of medical vacancies at U.S. Immigration and Customs Enforcement (ICE) detention facilities to determine whether existing medical staffing plans and vacancies at detention facilities hinder ICE detainees’ access to adequate medical care.
OIG found that ICE relies on a patchwork of detention facilities, governed by a variety of contracts and payment agreements, to house detainees. Regardless of how medical care is provided, facilities face challenges recruiting, hiring, and retaining medical staff. Specifically, remote locations, competing opportunities, difficulty offering competitive pay rates, and cumbersome hiring processes adversely affect ICE’s ability to attract qualified staff. However, the watchdog noted that it is difficult to measure medical vacancy rates as facility requirements are fluid, and strategies for ensuring adequate coverage vary widely.
The review also found that ICE has limited options to impose consequences if contractors do not meet staffing contract terms. Challenges ICE faces in recruiting medical staff require resource-intensive mitigation. Many of the challenges ICE faces hiring medical staff also affect ICE’s access to offsite specialty care. Remote locations and reluctance among some medical specialists to treat detainees further reduce access to specialty care. OIG said ICE’s options are also constrained by its reimbursement system, because compensation rates are outside ICE’s control. Medical vacancies may increase the risk of inadequate care, but the full effects of medical vacancies are difficult to evaluate. The unusual circumstances presented by COVID-19 limited OIG’s ability to assess the costs and effects of medical vacancies during the period of the review.
OIG made five recommendations as a result of its review:
- Evaluate the feasibility of offering hiring and retention incentives for high-demand Public Health Service and General Schedule healthcare professionals. Provide evaluation results.
- Evaluate staffing in Immigration and Customs Enforcement units supporting Immigration Health Service Corps personnel to ensure there are adequate staff to expedite processing applications for medical positions. Provide evaluation results.
- Evaluate the feasibility of including specific medical staffing requirements in future contract negotiations. Provide evaluation results.
- Evaluate current staffing levels for Field Medical Coordinators to determine whether additional staff could enable more effective oversight of contract medical care. Provide evaluation results.
- Integrate Immigration Health Service Corps personnel in contract re-negotiations with medical providers to create more oversight of medical staffing and its requirements.
ICE officials concurred with all five recommendations and is in the process of developing a Special Salary Pay Rate proposal which would be used to hire staff for hard-to-fill healthcare professions at certain sites. ICE is also exploring other recruitment and retention incentives for new recruits and current employees. All work to address the recommendations is expected to be completed by the end of March, 2022.