Alfredo Aranda-Holguin is a severely ill legal permanent resident (LPR) who, according to his family, has been hospitalized five times since being taken into Immigration and Customs Enforcement (ICE) custody on August 8. At the time of one of his first hospitalizations in August, Karla Aranda, Alfredo’s wife, was informed not by ICE, but by another detainee that her husband may have died.

“I received a call saying my husband died. The person who informed me was another detainee in [Alfredo’s] area,” Karla told Rewire in a phone interview. “He called me and said [Alfredo] was transferred to the hospital, that they [detainees] found him unconscious and [Adelanto Detention Center staff] tried CPR on him. The man told me they put a sheet over him.”

After receiving the distressing phone call, Karla and Alfredo’s attorney, Raul Saldana, tried for days to get answers from ICE about Alfredo’s condition and whereabouts. This same scenario—a call from a detainee, silence from ICE, and uncertainty regarding Alfredo’s health and well-being—has played out multiple times in the three months Alfredo has been detained. Karla told Rewire that each time, she fears the worst.

Alfredo has stage 3 kidney disease, hypertension, and type 2 diabetes. His kidneys are failing rapidly, his wife explained. When he entered ICE custody, Alfredo’s kidneys were functioning “a little above” 20 percent. Alfredo recently told Karla that his kidneys are now operating at 8 percent, according to his Adelanto doctor.

As Jorge Rivas of Splinter reported on the same story, medical records the publication reviewed from June indicated Alfredo “was prescribed six different drugs, including a daily shot of insulin to treat his diabetes. He was also taking a drug to reduce the amount of water his body stores and another pill that acted as a blood thinner.”

“Alfredo said the [Adelanto] doctor told him that if he doesn’t get the right medical attention, he will die soon,” Karla told Rewire. “The doctor said there’s nothing he can do because he’s already talked to immigration [officials] and they don’t want to listen.”

Alfredo needs dialysis, but ICE or GEO Group, the private prison company that contracts with ICE to run the Adelanto Detention Center, apparently are not providing the medical treatment to him. When reached for comment, a GEO Group representative told Rewire in an email that the company is “unable to discuss or disclose information related to any specific or individual medical cases,” and that any further questions should be referred to ICE.

The GEO representative also provided a statement saying the detention center has a “long-standing record providing high-quality, culturally responsive services, including comprehensive, around the clock medical care, in a safe, secure, and humane environment that meets the needs of individuals in the care and custody of federal immigration authorities.”

“The services at the Adelanto Center are provided by GEO and its medical care subcontractor, Correct Care Solutions, pursuant to strict contractual requirements and performance-based national detention standards,” the private prison company said.

Numerous reports contradict the company’s claims. A Nation investigation in January 2016 raises questions about Correct Care Solutions’ record on providing quality care as well. Both GEO Group and Correct Care Solutions have been accused of medical neglect.

First implemented in 2011 and further expanded under President Obama, the Performance-Based National Detention Standards (PBNDS) were created “to tailor the conditions of immigration detention to its unique purpose while maintaining a safe and secure detention environment for staff and detainees,” according to ICE. Essentially, these are standards of care that ICE and private prison companies that contract with the agency must adhere to.

Under PBNDS, any detained person “who is determined to require health care beyond facility resources shall be transferred in a timely manner to an appropriate facility.” Also according to PBNDS, any detained person “who requires close, chronic or convalescent medical supervision” will be “treated in accordance with a written treatment plan conforming to accepted medical practices for the condition in question, approved by a licensed physician, dentist or mental health practitioner.”

Karla told Rewire she personally faxed Alfredo’s medical records to Adelanto the week he was detained there, but was told by officials the information was “destroyed” because the medical records had to come directly from a doctor. As a result, Karla said she had Alfredo’s doctor’s office fax the documents to Adelanto, including his order to receive dialysis.

As Rivas reported for Splinter, “ICE did not confirm or deny they destroyed these records, but in an email ICE spokesperson Lori K. Haley wrote that ‘it would be standard procedure for medical staff to not provide medication to a detainee based on prescriptions that cannot be properly verified.'”

Earlier this month, Alfredo was hospitalized again for two weeks when he was given a pacemaker. Again, Karla says that she was stonewalled by ICE and not immediately provided information on her husband’s health, well-being, or whereabouts. When she was able to reach an ICE official, he granted her permission over the phone to visit Alfredo at the St. Mary Medical Center. That day, she made the approximately 90-mile trek to Adelanto, California, from her home in Maywood, a neighborhood in southeast Los Angeles. Once at the hospital, however, she was barred from seeing Alfredo for nearly four hours because a security guard at the facility told her that they had not received an official request from ICE to allow the visitation. When she was finally permitted to enter Alfredo’s room, it was for no more than two or three minutes, she said, and she had to hold her hands up in the air “like a prisoner” as she spoke to Alfredo, who was shackled to the hospital bed.

Afterwards, it was ten days before Karla received any word from ICE regarding Alfredo’s condition. It was then that she learned he had been transferred back to Adelanto without the care he needed.

“The way they are treating us, they way they are treating Alfredo, it’s not human. Can you imagine what it would be like? We didn’t know if he was alive or dead,” Karla said. “This is like kidnapping. It’s like [ICE is] allowed to kidnap a person.”

A spokesperson with the St. Joseph Health System, which oversees St. Mary’s, told Rewire in a post-publication statement that “once the authorities (law enforcement) become involved they are responsible for and control all patient information and access.”

Karla told Rewire she fears Alfredo will be the next in-custody death at the Adelanto Detention Center, where three immigrants died in the span of three months earlier this year.

Karla’s account of the care her husband is receiving mirrors other stories that have come out of the facility in recent years. Allegations of substandard medical care have regularly emerged from Adelanto. The problem has reportedly been so widespread that in July 2015, “29 members of Congress sent a letter to ICE and federal inspectors requesting an investigation into health and safety concerns at the facility. They cited the 2012 death of Fernando Dominguez at the facility, saying it was the result of ‘egregious errors’ by the center’s medical staff, who did not give him proper medical examinations or allow him to receive timely off-site treatment,” according to Mother Jones. 

“There have been times my husband was at the hospital and they denied he was a there or lied about how serious it was,” Karla said, referring to ICE. “I started to reach out to [Spanish language] media to put pressure on [ICE], but at first my husband asked me to stop because they would retaliate against him for the attention. They wouldn’t give him a blanket or check his blood sugar.”

But Alfredo recently told Karla he fears “something really bad” is going to happen to him while he’s detained at Adelanto, and gave her permission to share his story.

“It’s important for people to know what’s going on inside these places. Immigration officials “don’t respect human life. They know my husband is very sick and they’re not taking care of him. I’m not asking that Alfredo get special attention; I’m just asking that they treat my husband with dignity and give him the medical attention he needs.”

“They’re Playing With My Husband’s Life”

Like many immigrants, Alfredo was funneled into the detention system as a result of something called “crimmigration,” a term coined in 2006 by legal scholar Juliet Stumpf describing the intersection of criminal law and immigration law. The overlapping of these two systems allows the federal government to achieve two goals: detain people suspected of committing crimes and reduce the number of unauthorized immigrants in the country.

Karla said Alfredo was wrongly convicted of a drug-related offense and was given poor legal advice by his then-attorney, who instructed Alfredo to plead no contest. He was sentenced to one year in prison, but after serving just a few weeks, he was transferred to ICE custody, despite being a legal permanent resident for decades.

“When I found out he got taken to Adelanto, I decided to read about [the facility] and then I got really scared. There were so many reports of people dying there because of lack of medical care,” Karla said.

In the last three months, Alfredo has lost a significant amount of weight, Karla said, and ICE has not provided any clear answers as to why Alfredo is not receiving the care his doctor is recommending.

“When Alfredo was first sent to Adelanto, [ICE officials] said that Alfredo didn’t need dialysis. After he was hospitalized in August, [ICE officials] said he did need it, but they were waiting for a specialist,” Karla explained. But during a November 19 visit with Alfredo after he received his pacemaker, Karla was told by Alfredo that ICE told him dialysis was “too expensive” and that they didn’t have the specialist needed to provide the care. So they simply weren’t going to.

“I was also told another time that my husband was receiving dialysis. They are acting like this is a joke,” Karla said, referring to ICE. “They’re playing with my husband’s life.”

Even as a legal permanent resident, Alfredo’s criminal conviction made him a candidate for mandatory detention, meaning being released on bond is not an option for him, even if it would allow him to access the care he requires. Essentially, ICE can detain Alfredo indefinitely, even when the agency ultimately plans to deport him.

“If they know they’re going to deport him, why not let him be with his family and get the medical care he needs before they give him a date to leave?” Karla said.

Detaining people is big business, especially under the Trump administration, which is moving to drastically increase the already unwieldy detention system. At least 12 people died in ICE custody in fiscal year 2017, which concluded at the end of September, according to a release from ICE. Private prison stocks have doubled since President Trump’s election victory.

Cities like Adelanto are also profiting off immigrants in detention. In 2016, the City of Adelanto, “acting as a middleman between ICE and GEO, made a deal to extend the company’s contract until 2021,” according to Mother Jones. This means the federal government guarantees GEO that a minimum of 975 immigrants will be held at the facility, paying them $111 per detainee per day. After 2021, ICE only has to pay $50 per detainee per day—”an incentive to fill more beds,” Mother Jones reported.

“We are going to fight for Alfredo really hard, but his case is difficult because of his conviction. The family maintains he was wrongly convicted, but the charge is there and because of the way ICE picked him up, he is in mandatory detention,” Saldana said. “My biggest fear for Alfredo is that he is not going to receive the medical care he needs, his condition will get worse, and he will die in Adelanto.”

Saldana wasn’t even made aware of Alfredo’s most recent hospitalization or his whereabouts until November 15, the day before Alfredo had a court date on November 16. Saldana told Rewire he was cleared to visit Alfredo in the hospital just 24 hours before their scheduled court time.

“There are a lot of really scary, troubling aspects of Alfredo’s case, and this is another part of it: blocking access to counsel,” Saldana said. “I’ve had clients in ICE custody before, but I’ve never seen anything like Alfredo’s case. Sometimes ICE says he’s in detention when he’s actually at the hospital. Other times they tell me he’s unavailable for visits. I don’t know why they’re doing this, but I do know it’s a violation of his rights.”

When Saldana visited Alfredo in the hospital on November 15, ICE agents were present for the entirety of the visit, forcing the attorney and his client to whisper behind a curtain with agents just a few feet away.

“Being able to talk to my client and exchange information, having that attorney-client privilege, is obviously really important. I need to be able to safely and securely exchange information with Alfredo and the other day, they prevented me from doing that. I find that really unacceptable,” Saldana said.

Alfredo has an upcoming hearing regarding his case on December 14, but Karla worries that if they aren’t able to get Alfredo released from Adelanto before then, he will die.

In a visit with her husband on Tuesday, Karla said Alfredo was both physically and mentally “unrecognizable” to her.

“My husband looks really sick. His eyes, his face, he looks different. He is losing weight. He doesn’t look like the person I know, and he doesn’t act like the person I know,” Karla said. “My [14-year-old] son and I started crying during the visit because at one point, he looked very confused. Like he didn’t know who we were or what we were talking about.”

In a different way, Karla has now found herself fighting for survival too.

“Alfredo supported us and right now, I’m in a position where my son and I are [now] homeless. I’m really scared. Every day I wake up and I worry my husband isn’t alive. Every day I wake up and I wonder what will happen to us,” Karla said. “I want people to understand that Alfredo isn’t perfect, but he also isn’t who they try to portray him as. He is a human being and he has the right to live and get the medical attention he needs. How many people have to die at Adelanto before people care?”

UPDATE: This piece has been updated to include a post-publication statement from the St. Joseph Health System.