Commentary Human Rights

Immigration Detention Reform: A Matter of Life and Death

Meghan Rhoad

Women detained by ICE, roughly 10 percent of the detention population, have special medical concerns and face unique challenges in detention.

This article is one in a series on immigrant rights and attacks against immigrants being published by Rewire in partnership with the National Coalition for Immigrant Women’s Rights.  See all articles in this series here.

I’ve been waiting to give Antoinette L. some good news since the day I met her in May 2008. It was a hot day in Arizona, and I sat waiting inside a chilly interview room in a private prison under the watchful eye of a guard stationed just beyond a windowed door. A colleague and I had been interviewing women in Immigration and Customs Enforcement (ICE) custody about their ability to get adequate medical care.

I stood up and felt a surge of nervous energy as guards led in the next detainee on our list. With her hair pulled back and wearing the standard blue uniform, Antoinette L. entered the room and in her face I saw the same anticipation I felt. Each of the interviews so far had been significant and momentous in its own way, with women sharing incredibly personal information in the hope that it would contribute to making the system better for the women who came after them. But this next interview had a particular significance. Antoinette was the reason I was here.

In January 2008, women detained by ICE at a particular facility in Arizona had written a letter to legal aid and human rights groups decrying the conditions of their detention, including the medical care provided:

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Medical care that is provided to us is very minimal and general…. If you do not speak English, you cannot fuss, the only thing you can do is go to bed & suffer…. We have no privacy when our health record is being discussed…. When we’ve complained to the nurses, we get ridiculed with replies like: “You should have made better choices … ICE is not here to make you feel comfortable … our hands are [tied] … Well, we can’t do much you’re getting deported anyway … learn English before you cross the border … Mi casa no es su casa.”…. Our living situation is degrading and inhuman.

The letter sent shock waves through the advocacy community. It summed up with heartbreaking eloquence so many of the problems that had surfaced in immigration detention, the nation’s fastest growing form of incarceration, which now jails over 400,000 people per year while   their civil immigration cases are being processed. Further, it detailed the plight of women detainees, roughly 10 percent of the detention population, who have special medical concerns and face unique challenges in detention.

The driving force behind this letter was Antoinette L., a pseudonym to protect her privacy. A divorced mother of two, Antoinette had lived in the United States more than two decades, working, paying taxes, and raising her young boys. She now faced deportation to Haiti, a country her family had fled 22 years ago and where she still feared for her safety.When we met at the prison in Florence, Arizona, Antoinette had been in ICE custody almost six months. Her older son, 12, was just about to have his first communion. He and his younger brother were staying with her sister, who had to leave the last year of her medical residency to take care of them. They asked for their mom every night.

“You came,” she said when the guards had left and we hugged briefly before sitting down. She then shocked me with the news that she had recently signed a deportation order that would send her back to Haiti. I was taken aback that the brave woman who had written that impassioned letter, and who had so much tying her to this country, had stopped fighting deportation. But she explained she’d had no choice.

In December, she began feeling sharp pains in her left breast, where two lumps were found. At the same time, she started to experience dizziness and blurry vision in her left eye. She had difficulty moving one of her legs when she woke up in the morning and needed help from her bunkmate to get down from her bed. Her leg was bruised where she had stabbed herself with a plastic fork trying to wake her leg out of its numb state.

She brought all these problems to the attention of the medical authorities in the detention center, but as her condition worsened, efforts to treat her stalled. Authorizations for treatment were said to be held up in Washington. She said one of the medical staff told her that if he were in her position he wouldn’t wait around because the care might never come. Eventually, she came to the same conclusion. She described her difficult decision not to appeal a negative decision in her immigration case:

I’m not going to appeal… I can’t even get up to go to court. Appealing means me going back to [the detention center] and I’m not well. I worry about my breast a lot. I told my family, “Don’t ask me to [appeal my immigration case].” I’m not well and I would have to stay without medical care. I don’t know from month to month … things can get worse in my breast. It’s hurting me. What was I supposed to do, die of cancer here? With adequate care, yes, I would stay until the end. Because 22 years of my life [have been in the US]. My kids are 10 and 12 and the United States is all they know. Depression, inadequate food, detention? Yes, still I would have fought it indefinitely.

In terms of the life-or-death stakes, the wrenching decision Antoinette described was extraordinary among the many struggles to obtain medical care that women in detention had told me about.  But in many other ways, her experience reflected familiar themes. 

In our interviews we found that women in immigration detention did not have accurate information about available health services. Care and treatment were often delayed and sometimes denied. Confidentiality of medical information was often breached. Women had trouble getting access to facility health clinics and persuading security guards that they needed medical attention. Interpreters were not always available during exams. Security guards were sometimes inside exam rooms even when there was no security risk, invading privacy and encroaching on the patient-provider relationship. Some women feared retaliation or negative consequences to their immigration cases if they sought care.  A few were not given the option to refuse medication or received inappropriate treatment. Many detained women and their health care providers at other facilities were not able to obtain full medical records upon transfer or release. Women’s written complaints about poor medical care through official grievance procedures went ignored. The list goes on.                        

We met women who required screening and treatment for breast and cervical cancer but experienced extended delays and outright denials. We met women who complained of inadequate care during pregnancy, including one diagnosed with an ovarian cyst that threatened her five-month pregnancy shortly before she was detained who never got to see a doctor.  We met pregnant women who did get a doctor’s appointment, but who were taken there shackled. We met mothers who were nursing their babies prior to detention and were then denied breast pumps in the facilities, resulting in fever, pain, mastitis, and the inability to continue breastfeeding upon release.

 We met women who had to beg, plead, and in some cases do chores within the facility just to get enough sanitary pads not to bleed through their clothes, and one woman who sat on a toilet for hours when the facility would not give her the pads she needed.  We met women who sought mental health care for pre-existing conditions, including the effects of trauma, and for the stress of detention but found that the crisis orientation of the services that were available meant they could not get  counseling, and could expect to be put in isolation if their condition deteriorated to the point where they were suicidal.  

At the end of our interview, Antoinette and I promised to stay in touch, and we have. She has been a partner in getting the word out about the situation in detention. After our report went out in March 2009, Antoinette took press calls from journalists even though she had already been deported to Haiti. I’ve kept her updated on advocacy developments, but she’s been waiting for the good news, for the news that things have changed.

For a while, I thought the wait wouldn’t be long. In the wake of a number of organizations’ reports, government studies and investigations by journalists into the poor state of immigration detention, the Obama administration came in announcing its intention to reform the system. Dora Schriro, an expert on prisons, came on board as a special adviser to Homeland Security Secretary Janet Napolitano and conducted an intensive examination of the system. In her concluding report, she noted the need for special attention to the needs of women detainees. The announcement of the first concrete plans for reforming the detention system included a plan to create an all-female detention center with a  non-penal  detention model and that would try pilot programs to address women’s needs.  Congress was watching reform efforts as well, with several members actively following the situation for women detainees.

At the same time a group of organizations including the National Coalition for Immigrant Women’s Rights (chaired by the National Asian-Pacific American Women’s Forum and the National Latina Institute for Reproductive Health), the Women’s Refugee Commission, the ACLU, Legal Momentum, the Southwest Institute for Research on Women, and Human Rights Watch engaged the administration in a dialogue on recommendations for addressing specific women’s health issues. Staff members at ICE were immersed in developing a reformed set of standards to govern detention conditions, and they sought input from a wide range of stakeholders.

The pinnacle of this period of optimism came with the announcement of a complete draft of those new standards in early 2010. In addition to revising the existing standards, the administration had created a new standard to address women’s health. The standard represented a major improvement on multiple fronts:  shackling pregnant women would be prohibited in all but extraordinary circumstances, women would have access to life-saving preventive screenings like Pap tests and mammograms, new protections would be in place for detainees’ reproductive rights, medical staff would screen detainees to determine if they had been sexually assaulted and make appropriate services available. These important policy improvements were just one step away from being finalized and implemented. I planned to tell Antoinette as soon as they went into effect.

Unfortunately, more than a year later, they remain that one critical step away. Various reasons for the holdup have circulated, but the one that has dominated is that the ICE officers’ union has objected. The details of the discussion between ICE and the union are not public, but union statements indicate its views. In July 2010, the union took a vote of no confidence in Assistant Secretary for Immigration and Customs Enforcement John Morton and in Phyllis Coven, who was then the director of the ICE Office of Detention Policy Planning. The statement accompanying the vote characterized the detention reform efforts as “aimed at providing resort-like living conditions for criminal aliens” and said that certain provisions would compromise officer safety.

Negotiations between employers and unions are essential for giving employees a voice in the conditions that affect their jobs and should be respected. The human rights obligations of the government, however, cannot be negotiated away. While the substance of the conversations between the union and ICE is unknown, it is clear that the revised detention standards have been on hold too long, and that what hangs in the balance are not resort-type amenities, but critical matters of detainee health, safety and dignity.

Adding to that, in January, the Justice Department  issued proposed regulations under the Prison Rape Elimination Act of 2003 (PREA) that exclude immigration detention from rules  to prevent and respond to rape in custodial settings. Tragically, there have been numerous documented incidents of sexual assault against immigration detainees, including the assault of a number of women last May by a contract guard, who assaulted women under the guise of searching them when he transported them from a Texas detention facility. The legislative history of PREA demonstrates that it was intended to cover just these sorts of incidents, including in immigration detention. But if the DOJ’s propose rule goes unchanged, women and men in civil immigration detention will be denied the protection that will be afforded to criminal prisoners around the country.

Both of these issues demand action by the Obama administration at the highest levels. The Obama administration has trumpeted its status as the administration to deport the most people in a single year. What this means is that more people than ever have been run through a system the administration itself recognized as dangerously flawed and in which reform has stagnated. It is incumbent upon the White House to jump-start the process of getting the new detention standards into place and to take the lead in ensuring that immigration detainees are covered by regulatory protections against sexual assault.

At the same time, the administration should examine the need for massive detention operations – a system for which there are less costly alternatives, such as supervised release in the community, that spare individuals the separation from their family and other suffering that comes with incarceration. Failing such efforts on the part of the administration, Congress should intervene to ensure that the nation does not operate a detention system at odds with basic human rights and fundamental American values.

I’ve been waiting to give Antoinette some good news for a long time now. She is still struggling with her health in Haiti and she is still passionate about the treatment of women in immigration detention. I don’t want to tell her that the health of women detainees has been sidelined, that they have been written out of rules that would have protected their safety. I don’t want to tell her that three days ago, in the course of research for another project, I interviewed a woman who described detention medical care in terms similar to the ones she did three years ago.   I would like to tell her that in a moment of tremendous challenges, the US government stepped up and did the right thing.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

Commentary Sexuality

Black Trans Liberation Tuesday Must Become an Annual Observance

Raquel Willis

As long as trans people—many of them Black trans women—continue to be murdered, there will be a need to commemorate their lives, work to prevent more deaths, and uplift Black trans activism.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

This week marks one year since Black transgender activists in the United States organized Black Trans Liberation Tuesday. Held on Tuesday, August 25, the national day of action publicized Black trans experiences and memorialized 18 trans women, predominantly trans women of color, who had been murdered by this time last year.

In conjunction with the Black Lives Matter network, the effort built upon an earlier Trans Liberation Tuesday observance created by Bay Area organizations TGI Justice Project and Taja’s Coalition to recognize the fatal stabbing of 36-year-old trans Latina woman Taja DeJesus in February 2015.

Black Trans Liberation Tuesday should become an annual observance because transphobic violence and discrimination aren’t going to dissipate with one-off occurrences. I propose that Black Trans Liberation Tuesday fall on the fourth Tuesday of August to coincide with the first observance and also the August 24 birthday of the late Black trans activist Marsha P. Johnson.

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There is a continuing need to pay specific attention to Black transgender issues, and the larger Black community must be pushed to stand in solidarity with us. Last year, Black trans activists, the Black Lives Matter network, and GetEQUAL collaborated on a blueprint of what collective support looks like, discussions that led to Black Trans Liberation Tuesday.

“Patrisse Cullors [a co-founder of Black Lives Matter] had been in talks on ways to support Black trans women who had been organizing around various murders,” said Black Lives Matter Organizing Coordinator Elle Hearns of Washington, D.C. “At that time, Black trans folks had been experiencing erasure from the movement and a lack of support from cis people that we’d been in solidarity with who hadn’t reciprocated that support.”

This erasure speaks to a long history of Black LGBTQ activism going underrecognized in both the civil rights and early LGBTQ liberation movements. Many civil rights leaders bought into the idea that influential Black gay activist Bayard Rustin was unfit to be a leader simply because he had relationships with men, though he organized the 1963 March on Washington for Jobs and Freedom. Johnson, who is often credited with kicking off the 1969 Stonewall riots with other trans and gender-nonconforming people of color, fought tirelessly for LGBTQ rights. She and other trans activists of color lived in poverty and danger (Johnson was found dead under suspicious circumstances in July 1992), while the white mainstream gay elite were able to demand acceptance from society. Just last year, Stonewall, a movie chronicling the riots, was released with a whitewashed retelling that centered a white, cisgender gay male protagonist.

The Black Lives Matter network has made an intentional effort to avoid the pitfalls of those earlier movements.

“Our movement has been intersectional in ways that help all people gain liberation whether they see it or not. It became a major element of the network vision and how it was seeing itself in the Black liberation movement,” Hearns said. “There was no way to discuss police brutality without discussing structural violence affecting Black lives, in general”—and that includes Black trans lives.

Despite a greater mainstream visibility for LGBTQ issues in general, Black LGBTQ issues have not taken the forefront in Black freedom struggles. When a Black cisgender heterosexual man is killed, his name trends on social media feeds and is in the headlines, but Black trans women don’t see the same importance placed on their lives.

According to a 2015 report by the Anti-Violence Project, a group dedicated to ending anti-LGBTQ and HIV-affected community violence, trans women of color account for 54 percent of all anti-LGBTQ homicides. Despite increased awareness, with at least 20 transgender people murdered since the beginning of this year, it seems things haven’t really changed at all since Black Trans Liberation Tuesday.

“There are many issues at hand when talking about Black trans issues, particularly in the South. There’s a lack of infrastructure and support in the nonprofit sector, but also within health care and other systems. Staffs at LGBTQ organizations are underfunded when it comes to explicitly reaching the trans community,” said Micky Bradford, the Atlanta-based regional organizer for TLC@SONG. “The space between towns can harbor isolation from each other, making it more difficult to build up community organizing, coalitions, and culture.”

The marginalization that Black trans people face comes from both the broader society and the Black community. Fighting white supremacy is a full-time job, and some activists within the Black Lives Matter movement see homophobia and transphobia as muddying the fight for Black liberation.

“I think we have a very special relationship with gender and gender violence to all Black people,” said Aaryn Lang, a New York City-based Black trans activist. “There’s a special type of trauma that Black people inflict on Black trans people because of how strict the box of gender and space of gender expression has been to move in for Black people. In the future of the movement, I see more people trusting that trans folks have a vision that’s as diverse as blackness is.”

But even within that diversity, Black trans people are often overlooked in movement spaces due to anti-Blackness in mainstream LGBTQ circles and transphobia in Black circles. Further, many Black trans people aren’t in the position to put energy into movement work because they are simply trying to survive and find basic resources. This can create a disconnect between various sections of the Black trans community.

Janetta Johnson, executive director of TGI Justice Project in San Francisco, thinks the solution is twofold: increased Black trans involvement and leadership in activism spaces, and more facilitated conversations between Black cis and trans people.

“I think a certain part of the transgender community kind of blocks all of this stuff out. We are saying we need you to come through this process and see how we can create strength in numbers. We need to bring in other trans people not involved in the movement,” she said. “We need to create a space where we can share views and strategies and experiences.”

Those conversations must be an ongoing process until the killings of Black trans women like Rae’Lynn Thomas, Dee Whigham, and Skye Mockabee stop.

“As we commemorate this year, we remember who and why we organized Black Trans Liberation Tuesday last year. It’s important we realize that Black trans lives are still being affected in ways that everyday people don’t realize,” Hearns said. “We must understand why movements exist and why people take extreme action to continuously interrupt the system that will gladly forget them.”

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