California’s largest ICE facility neglected detainees’ medical needs, monitor finds

Court-appointed investigator finds California City facility failed to comply with judge’s order to provide adequate healthcare

California’s largest immigration detention center has failed to comply with a judge’s orders to provide adequate healthcare, according to a court-appointed monitor who found the facility was struggling to meet a wide range of medical standards.

The California City detention center, located north-east of Los Angeles, was found to have major flaws in the care it provides residents, including significant gaps in emergency care, failures to provide medications in a timely manner, inadequate screenings for health conditions and a lack of accommodations for people with disabilities.

A federal judge had ordered the inquiry in February in response to a lawsuit alleging medical neglect. The judge demanded the government demonstrate it was providing required medical treatment across eight components of California City’s healthcare system.

The California City detention facility was out of compliance with all eight areas identified by the judge, said the monitor, Dr Muthusamy Anandkumar, in a report filed with the court on Monday, writing: “The facility lacks a reliable system to consistently provide adequate health care, placing individuals at serious risk of both immediate and long-term harm.”

The findings are significant as this is the first court-ordered investigation of the full scope of medical care at any Immigration and Customs Enforcement (ICE) facility in the US, according to lawyers for the detained immigrants. The monitor’s conclusions echo some of the significant concerns that residents have raised about conditions and healthcare over the last year.

The report comes as the Trump administration is arresting a record number of immigrants, with more than 65,000 people in ICE detention as of 11 July, prompting growing concerns across the country about overcrowding and dangerous and potentially deadly conditions in custody.

Anandkumar suggested the failings were structural, writing: “This pattern indicates broader problems in the facility’s health care delivery system rather than occasional lapses in care.”

The case originated with a class-action lawsuit filed in November, brought by seven detained plaintiffs who alleged “life-threatening” problems with healthcare. The complaint included claims the facility was denying cancer treatment, regular insulin for diabetes and basic disability accommodations.

In her February order, US judge Maxine Chesney outlined the areas of the system that ICE needed to ensure were properly functioning in the California City facility: adequate healthcare staffing; appropriate and timely medical screenings; thorough primary care assessments; timely access to specialists; responsive emergency services; continuous care after intake, including access to appointments; timely access to prescribed medications; and a responsive “sick call” system for detainees to request care.

To assess those areas, the judge appointed Anandkumar, a physician who previously served as a medical expert for the Department of Homeland Security (DHS) and has a history of auditing ICE detention centers and the healthcare of local jail systems.

A DHS spokesperson did not respond to questions about the monitor’s findings, but maintained that it provides “comprehensive medical care” to detained people.

CoreCivic, the private prison corporation, operates the facility but is not a defendant in the lawsuit. Ryan Gustin, a CoreCivic spokesperson, said the company was still reviewing the monitor’s report, but said “nothing matters more to CoreCivic than the health, safety and well-being of the people in our care”. He said an on-site ICE officer was responsible for “monitoring compliance with applicable ICE detention standards and policies”.

The monitor’s report was based on an inquiry over several months that included a review of 141 medical records, a three-day site visit in May and interviews with 40 patients and with staff.

The California City detention center is located on the grounds of a former state prison. When the facility opened as an ICE detention center last year, staff said it was intended to house people “in good health”, according to the monitor, but instead received many people with complex medical needs.

Staff shortages have been so severe that some staff were moved to clinical duties before they finished orientation, and staff who were not yet fully trained have been tasked with training others, Anandkumar said.

The lack of comprehensive intake screenings means “urgent or serious conditions” might be missed, delaying essential healthcare and allowing treatable conditions to worsen, the monitor found. Physical exams and record-keeping were also inadequate, with doctors simply writing “WNL” for “within normal limits” instead of documenting specific findings for patients’ systems, such as “lungs clear”, the report said.

There were cases where patients reported specific problems, but no examination was documented for the body parts related to the symptoms, the monitor said, writing: “This is the most basic step in evaluating a medical complaint … This creates a risk that the very problem the patient came in with was not properly evaluated.”

The process of referring people to specialists was also disorganized and inadequate, the monitor said, with patients waiting for referrals past deadlines noted in their medical records or people being denied referral without a documented reason.

Patients with serious psychiatric needs requiring inpatient treatment outside the facility have instead been left to languish in detention until they “deteriorate” to such a degree that they are hospitalized. They are then returned to detention “often with little lasting improvement”, the report said.

A patient who uses a wheelchair reported being injured during transport to an outside facility on two separate occasions, the monitor wrote, saying staff acknowledged the incidents and said the patient received further medical assessments. Another patient with a disability reported that he was left in the shower area “for a long time” because no one escorted him back, and people with disabilities said they had to rely on roommates instead of trained staff to help with basic activities.

Patients taking medications for chronic diseases were found to not have consistent access to treatment, and the monitor described significant dysfunction with the medication delivery system, including some patients reporting they had to stay up until 2am to get medications that were supposed to arrive around 7pm. The monitor further reported seeing “loose pills” on the floor in a medication room, “indicating that medication handling and disposal practices were not consistently maintained”.

The 51-page report included recommendations to address the gaps in care and improve how it tracks medical care across the facility.

Gustin, the CoreCivic spokesperson, said detainees had access to a wide range of services, including screenings, prevention, chronic care management and behavioral healthcare. He said staff coordinate with outside facilities when specialty care is required, adding: “While we work diligently to arrange and support those appointments, the scheduling, availability, and capacity of outside providers are not controlled by the facility.”

The California City facility follows “established clinical protocols” for managing medications, and pharmacy staff review medication orders and renewals and work with prescribers to “help ensure continuity of treatment”, Gustin said. For people with disabilities, he added, “facility staff work to identify needs, assess appropriate accommodations, and provide assistance and support consistent with medical recommendations, operational requirements, and applicable standards”.

Tess Borden, managing attorney at the Prison Law Office, which is representing the detained people who sued the government, said in a statement that the monitor’s findings “tell a nightmarish story – psychiatric patients left without follow-up, medication and culture specimens improperly stored, specialist appointments that were missed or never scheduled”.

She added: “This report confirms what thousands of people have experienced firsthand: in every area of health care, California City is failing.”