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Abstract: This Article challenges the lack of health care provided to individuals in U.S. Immigration and Customs Enforcement ("ICE") custody. As background, many immigration detainees are physically and emotionally vulnerable at the time of initial confinement due to a history of torture and trauma, which may include human trafficking, sexual violence, political oppression, psychosocial trauma, and acculturative stress. Detention can exacerbate preexisting vulnerabilities and contribute to severe physical and mental illness as well as death. Between October 2003 and October 2015, 153 individuals died while in ICE custody. Although most proposals for detainee health reform borrow heavily from constitutional law, international human rights law, and tort law, this Article argues that these areas of the law lack the specificity, enforceability, and ex ante perspective necessary, respectively, to effect comprehensive reform. Instead, this Article uses state and federal health law as a model for change. Involuntary commitment laws, long-term care facility laws, and behavioral health laws provide a lens through which the lack of access to health care in detention might be assessed and through which the unenforceable standards governing detention centers might be improved. This Article makes eight specific recommendations that, if promulgated by the Department of Homeland Security into legally enforceable regulations, will improve the health and safety of detainees.
INTRODUCTION
On April 6, 2015, Raul Ernesto Morales-Ramos, a forty-four-year-old Salvadoran national who had been in U.S. Immigration and Customs Enforcement ("ICE") custody since 2010, died of intestinal cancer. 1 The Adelanto Immigration Center in Adelanto, California ("Adelanto"), which ignored Morales-Ramos's complaints of severe abdominal pain, uncontrollable leakage of urine, and diarrhea, refused to provide the detainee any medical care. 2
On March 4, 2012, Fernando Dominguez Valdivia, a fifty-eight-yearold Mexican national, died of multiple organ failure caused by an infection that spread to his bloodstream following one hundred days in ICE custody, also at Adelanto. 3 Following an investigation of his death, the Federal Office of Detention Oversight ("ODO") determined that Adelanto's medical staff failed to properly examine Dominguez Valdivia, failed to create medical records that would ensure the continuity of his health care, and failed to access available, off-site health care. 4 The ODO concluded that the care Dominguez Valdivia received was unacceptable and that his death was preventable.5
Morales-Ramos and...