[House Hearing, 116 Congress]
[From the U.S. Government Publishing Office]
ASSESSING THE ADEQUACY OF DHS EFFORTS TO PREVENT CHILD DEATHS IN
CUSTODY
=======================================================================
HEARING
before the
SUBCOMMITTEE ON
BORDER SECURITY, FACILITATION,
AND OPERATIONS
of the
COMMITTEE ON HOMELAND SECURITY
HOUSE OF REPRESENTATIVES
ONE HUNDRED SIXTEENTH CONGRESS
SECOND SESSION
__________
JANUARY 14, 2020
__________
Serial No. 116-55
__________
Printed for the use of the Committee on Homeland Security
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Available via the World Wide Web: http://www.govinfo.gov
__________
U.S. GOVERNMENT PUBLISHING OFFICE
40-995 PDF WASHINGTON : 2020
COMMITTEE ON HOMELAND SECURITY
Bennie G. Thompson, Mississippi, Chairman
Sheila Jackson Lee, Texas Mike Rogers, Alabama
James R. Langevin, Rhode Island Peter T. King, New York
Cedric L. Richmond, Louisiana Michael T. McCaul, Texas
Donald M. Payne, Jr., New Jersey John Katko, New York
Kathleen M. Rice, New York Mark Walker, North Carolina
J. Luis Correa, California Clay Higgins, Louisiana
Xochitl Torres Small, New Mexico Debbie Lesko, Arizona
Max Rose, New York Mark Green, Tennessee
Lauren Underwood, Illinois Van Taylor, Texas
Elissa Slotkin, Michigan John Joyce, Pennsylvania
Emanuel Cleaver, Missouri Dan Crenshaw, Texas
Al Green, Texas Michael Guest, Mississippi
Yvette D. Clarke, New York Dan Bishop, North Carolina
Dina Titus, Nevada
Bonnie Watson Coleman, New Jersey
Nanette Diaz Barragan, California
Val Butler Demings, Florida
Hope Goins, Staff Director
Chris Vieson, Minority Staff Director
------
SUBCOMMITTEE ON BORDER SECURITY, FACILITATION, AND OPERATIONS
Kathleen M. Rice, New York, Chairwoman
Donald M. Payne, Jr., New Jersey Clay Higgins, Louisiana, Ranking
J. Luis Correa, California Member
Xochitl Torres Small, New Mexico Debbie Lesko, Arizona
Al Green, Texas John Joyce, Pennsylvania
Yvette D. Clarke, New York Michael Guest, Mississippi
Bennie G. Thompson, Mississippi (ex Mike Rogers, Alabama (ex officio)
officio)
Alexandra Carnes, Subcommittee Staff Director
Emily Trapani, Minority Subcommittee Staff Director
C O N T E N T S
----------
Page
Statements
The Honorable Kathleen M. Rice, a Representative in Congress From
the State of New York, and Chairwoman, Subcommittee on Border
Security, Facilitation, and Operations:
Oral Statement................................................. 1
Prepared Statement............................................. 3
The Honorable Clay Higgins, a Representative in Congress From the
State of Louisiana, and Ranking Member, Subcommittee on Border
Security, Facilitation, and Operations:
Oral Statement................................................. 4
Prepared Statement............................................. 6
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Chairman, Committee on
Homeland Security:
Oral Statement................................................. 7
Prepared Statement............................................. 8
Witnesses
Mr. Brian S. Hastings, Chief, Law Enforcement Operations
Directorate, U.S. Border Patrol, U.S. Customs and Border
Protection, U.S. Department of Homeland Security:
Oral Statement................................................. 9
Prepared Statement............................................. 11
Dr. Alexander L. Eastman, M.D., MPh, FACS, FAEMS, Senior Medical
Officer--Operations, Countering Weapons of Mass Destruction
Office, U.S. Department of Homeland Security:
Oral Statement................................................. 16
Prepared Statement............................................. 17
For the Record
The Honorable Bennie G. Thompson, a Representative in Congress
From the State of Mississippi, and Chairman, Committee on
Homeland Security:
Statement of the American Academy of Pediatrics................ 27
Appendix
Questions From Chairwoman Kathleen M. Rice for Brian Hastings.... 57
Questions From Chairman Bennie G. Thompson for Brian Hastings.... 57
Questions From Honorable Sylvia Garcia for Brian Hastings........ 58
Questions From Chairwoman Kathleen M. Rice for Alexander L.
Eastman........................................................ 58
Questions From Honorable Lauren Underwood for Alexander L.
Eastman........................................................ 58
ASSESSING THE ADEQUACY OF DHS EFFORTS TO PREVENT CHILD DEATHS IN
CUSTODY
----------
Tuesday, January 14, 2020
U.S. House of Representatives,
Committee on Homeland Security,
Subcommittee on Border Security,
Facilitation, and Operations,
Washington, DC.
The subcommittee met, pursuant to notice, at 10:06 a.m., in
room 310, Cannon House Office Building, Hon. Kathleen M. Rice
[Chairwoman of the subcommittee] presiding.
Present: Representatives Rice, Correa, Torres Small, Green,
Clarke, Thompson, Underwood, Garcia, Higgins, Joyce, and Guest.
Also present: Representatives Jackson Lee and Garcia.
Miss Rice. Subcommittee on Border Security, Facilitation,
and Operations will come to order. The subcommittee is meeting
today to receive testimony on assessing the adequacy of DHS
efforts to prevent child deaths in custody.
Without objection, the Chair is authorized to declare the
subcommittee in recess at any point.
The Chair asks unanimous consent that Representative
Underwood be permitted to sit and question the witnesses.
The Chair asks unanimous consent that Representative Garcia
be permitted to sit and question the witnesses.
Without objection, so ordered.
Jakelin Caal Maquin, 7 years old. Felipe Gomez Alonzo, 8
years old. Darlyn Cristabel Cordova-Valle, 10 years old. Juan
de Leon Gutierrez, 16 years old. Wilmer Josue Ramirez Vasquez,
2 years old. Carlos Hernandez Vasquez, 16 years old. These 6
children died in the custody of the U.S. Government just in the
past 18 months. These children were migrants from Central
America who died of preventible conditions that went untreated.
Three of these children spent the last hours of their lives in
detention facilities on our Southern Border.
We must never forget their names, their suffering, or the
terrible losses their families had to endure. So we are here
this morning to examine the conditions that led to these
avoidable tragedies. We have seen a dramatic increase in the
numbers of families and children arriving on the Southern
Border over the past several years. Most of these families and
children arrived from Central America, fleeing vicious cartels,
gang violence, and extreme poverty.
After surviving long dangerous journeys, these families
should have been met with safe refuge, but instead they
encountered this administration's myriad of inhumane border
policies like family separation, zero tolerance detention, and
the Remain in Mexico policy. These policies and management
decisions by the administration have contributed to mass
overcrowding and wide-spread inhumane conditions at Customs and
Border Protection facilities across our Southern Border.
Numerous reports by the DHS Office of Inspector General and
court observer attorneys confirm these intolerable conditions.
I have seen the problems with these facilities with my own eyes
along with several of my Congressional colleagues on this panel
today on both sides of the aisle. Yet when pressed about these
conditions, DHS has consistently failed to maintain
transparency by stymieing Congressional inquiries.
This raises concerns that they are hiding serious issues
with management, in addition to the leadership vacancies at the
top of the Department. One example of this is the Department's
decision to conceal information on the death of Carlos
Hernandez Vasquez. Carlos was a teenage boy from Guatemala, who
died tragically in U.S. custody on the morning of May 20, 2019.
CBP issued a press release later that day calling the death a
tragedy and declaring that they consider the health, safety,
and humane treatment of migrants to be of the highest priority.
However, despite information requests by this committee, it
was not until a ProPublica report was released 7 months later
that Congress and the public learned more about what happened
to Carlos, that his death may have been caused by the failure
to provide urgently needed medical care, and the failure to
follow the most basic procedures to simply check on a sick
child.
While I understand that this specific case is still under
investigation, this lack of transparency by the Department is
completely unacceptable. The Office of the Inspector General
must be doing everything in its power to examine the factors
that led to these tragedies. That is why I am extremely
disappointed that the current DHS inspector general declined
our invitation to testify this morning, especially given the
recent news that his office closed its investigations into the
first 2 child deaths in Border Patrol custody.
The publicly-available summaries of these investigations
are extraordinarily narrow in scope. They focus only on whether
DHS personnel committed malfeasance and not whether the
Department's policies and resources could properly protect the
children in its care.
For instance, even with these 2 completed reports, we still
do not know why Felipe Gomez Alonzo and his father were in CBP
custody for 6 days before Felipe passed away. I, along with
several other Members of this committee, remain concerned that
DHS still isn't doing enough to protect the children in its
custody.
Reporting over this past weekend indicates that CBP
continues to detain families with young children in need of
medical attention well beyond the 72 hours allowed by the
agency's own protocols. This is a disturbing pattern that needs
to be remedied immediately, or we risk losing more children to
preventible deaths in the future. We must act urgently to
ensure that the policies and decisions that contributed to
these tragic deaths are addressed.
I hope the witnesses here today are prepared to explain
whether the Department's current approach incorporates the
lessons learned after these tragedies and how they intend to
safeguard children in DHS custody going forward. As Members of
Congress, we may disagree about immigration policy, but there
should be no disagreement that the Federal Government must take
responsibility for the human beings in its custody,
particularly young children. We must never forget Jakelin,
Felipe, Darlyn, Juan, Wilmer, and Carlos, and we must never let
this happen to another child again.
I want to thank the witnesses for joining us, and I now
recognize the Ranking Member for his opening statement.
[The statement of Chairwoman Rice follows:]
Statement of Chairwoman Kathleen M. Rice
January 14, 2020
Jakelin Caal Maquin. Seven years old. Felipe Gomez Alonzo. Eight
years old. Darlyn Cristabel Cordova-Valle. Ten years old. Juan de Leon
Gutierrez. Sixteen years old. Wilmer Josue Ramirez Vasquez. Two years
old. Carlos Hernandez Vasquez. Sixteen years old. These 6 children died
in the custody of the United States Government in the past 18 months.
These children were migrants from Central America, who died of
preventable conditions that went untreated. Three of these children
spent the last hours of their lives in detention facilities on our
Southern Border. We must never forget their names, their suffering, or
the terrible losses their families had to endure. So, we are here this
morning to examine the conditions that led to these avoidable
tragedies.
We've seen a dramatic increase in the numbers of families and
children arriving on the Southern Border over the past several years.
Most of these families and children arrived from Central America,
fleeing vicious cartels, gang violence, and extreme poverty. And after
surviving long, dangerous journeys, these families should have been
with met with safe refuge. But instead, they encountered this
administration's myriad of inhumane border policies, like family
separation, ``zero tolerance'' detention, and the Remain in Mexico
policy. These policies and management decisions by the administration
have contributed to mass overcrowding and wide-spread inhumane
conditions at Customs and Border Protection facilities across our
Southern Border.
Numerous reports by the DHS Office of Inspector General and court
observer attorneys confirm these intolerable conditions. I have seen
the problems with these facilities with my own eyes, along with several
of my Congressional colleagues on this panel today. Yet when pressed
about these conditions, DHS has consistently failed to maintain
transparency by stymying Congressional inquiries. This raises concerns
that they are hiding serious issues with management, in addition to the
leadership vacancies at the top of the Department. One example of this
is the Department's decision to conceal information on the death of
Carlos Hernandez Vasquez. Carlos was a teenage boy from Guatemala, who
died tragically in U.S. custody on the morning of May 20, 2019. CBP
issued a press release later that day calling the death a tragedy, and
declaring that they consider the health, safety, and humane treatment
of migrants to be of the highest priority.
However, despite information requests by this committee, it was not
until a ProPublica report was released 7 months later that Congress and
the public learned the truth about what happened to Carlos. That his
death may have been caused by the failure to provide urgently-needed
medical care and the failure to follow the most basic procedures--to
simply check on a sick child. While I understand that this specific
case is still under investigation, this lack of transparency by the
Department is completely unacceptable. The Office of the Inspector
General must be doing everything in its power to examine the factors
that led to these tragedies. And that's why I am extremely disappointed
that the current DHS inspector general declined our invitation to
testify this morning. Especially given the recent news that his office
closed its investigations into the first 2 child deaths in Border
Patrol custody. The publicly available summaries of these
investigations are extraordinarily narrow in scope. They focus only on
whether DHS personnel committed malfeasance and NOT whether the
Department's policies and resources could properly protect the children
in its care.
For instance, even with these 2 completed reports, we still do not
know why Felipe Gomez Alonzo and his father were in CBP custody for 6
days before Felipe passed away. I, along with several other Members on
this committee, remain concerned that DHS still isn't doing enough to
protect the children in its custody. Reporting over this past weekend
indicates that CBP continues to detain families with young children in
need of medical attention well beyond the 72 hours allowed by the
agency's own protocols. This is a disturbing pattern that needs to be
remedied immediately, or we risk losing more children to preventable
deaths in the future. We must act urgently to ensure that the policies
and decisions that contributed to these tragic deaths are addressed. I
hope the witnesses here today are prepared to explain whether the
Department's current approach incorporates the lessons learned after
these tragedies, and how they intend to safeguard children in DHS
custody going forward. As Members of Congress, we may disagree about
immigration policy, but there should be no disagreement that the
Federal Government must take responsibility for the human beings in its
custody, particularly young children. We must never forget Jakelin,
Felipe, Darlyn, Juan, Wilmer, and Carlos. And we must never let this
happen to another child again.
Mr. Higgins. Thank you, Madam Chair, and I thank our
professionals for appearing before us today, the panelists. I
thank Chiefs Hastings and Dr. Eastman for your service at the
border and for being here today. I look forward to hearing in
greater detail about the actions DHS has taken to enhance
Customs and Border Protection's ability to handle migrants
arriving at our border in deteriorating health and to address
preventible deaths in custody.
The crisis that unfolded along our border last year was
real, was not the fault of the men and women of Customs and
Border Protection, wasn't the fault of the Executive branch,
nor the President of the United States. The truth is, this past
year, we saw record numbers of family units, unaccompanied
minors, large groups of 100 migrants or more--213 groups to be
exact--arriving at our border during the height of flu season
and during months of extreme heat. At the time, the Border
Patrol was referring 50 cases per day to medical professionals.
The border crisis was a result of legal loopholes, activist
judges, propaganda from criminal cartels, killers, who smuggle
and traffic migrants for profit. In 2014, under the Obama
administration, the number of unaccompanied minors encountered
at the border was viewed as crisis level, leading to former DHS
Secretary Johnson writing an open letter to Central American
parents, telling them to not send their children.
It is clear that sufficient, corrective actions were not
taken at that time. If that was a crisis, then there are no
words to describe what we experienced at the border during
fiscal year 2019. Not only were more than 321,000 minors
encountered by Customs and Border Protection, family unit
apprehensions were more than 590 percent higher in fiscal year
2019 as compared to fiscal year 2014.
Throughout the crisis, most CBP facilities were at or over
capacity. Customs and Border Protection personnel were working
overtime for more than a month without pay to process the large
groups. Resources were depleting at record time as key
personnel at the Department were furloughed. Yet Customs and
Border Protection law enforcement officers still scraped
together enough money out of their own pockets to buy toys and
bring extra supplies for the migrants in their custody, many of
them parents themselves, caring for and loving to the best of
their ability, the children in their custody.
After a 35-day shutdown that began in the end of 2018, the
Federal Government reopened in January 2019 and the crisis
continued. In light of the growing issues related to the mass
influx of migrants, President Trump made an official request to
Congress for supplemental funding for the border. Two months
went by before we sent that money to the field. My colleagues
across the aisle blocked a vote on supplemental assistance more
than 15 times. While leaders of the Majority party were
repeating the message of tweets like ``fake emergency,'' the
chief of the Border Patrol was testifying in front of Congress
that without the funding we may, ``lose the border''.
The bipartisan Homeland Security Advisory Council released
a report on the crisis stating that the delay in passing a
supplemental resulted in unaccompanied minors being held in
Customs and Border Protection facilities for dangerous lengths
of time. There are Members on this committee who voted against
the emergency supplemental.
A ``no'' vote meant a vote to keep unaccompanied minors in
Customs and Border Protection custody instead of at a
Department of Health and Human Services facility, suitable for
children. It meant releasing thousands of migrants on the
streets of border communities. Border county Sheriff Napier
testified before this committee that during the crisis, social
service resources that should address local issues of hunger
and homelessness are now completely unable to do so.
While the men and women of CBP were struggling to keep the
lights on at the border, they were the subject of partisan
attacks. One Member even claimed that the deaths of children in
custody were intentional, an ugly statement, an absurdity that
was completely debunked as the DHS inspector general found no
misconduct or malfeasance by DHS personnel upon completion of
their investigations into the heartbreaking deaths of Jakelin
and Felipe in December 2018.
Every life is precious and even 1 death in custody is too
many, which is why I was encouraged to learn about the
immediate steps CBP took to enhance their ability to diagnose
the health of migrants in custody and work with the DHS chief
medical officer to make long-needed, long-term improvements.
In December 2018, then commissioner Kevin McAleenan ordered
secondary medical checks on every child in custody and
initiated an internal evaluation of CBP care policies. Since
then, CBP established a phased approach to conducting health
interviews on all migrants during initial processing and a
subsequent full medical assessment of all unaccompanied minors
and at-risk adults.
On top of that, Customs and Border Protection now has over
700 medical personnel and contractors stationed across the
Southwest Border to provide medical support to migrants in
custody.
Today I look forward to hearing from our witnesses about
how CBP's in-custody medical capabilities have improved since
the fall of 2018, the collaboration process between CBP, the
office of DHS chief medical officer, and other relevant
stakeholders, to bolster Customs and Border Protection's
ability to stop preventible deaths in custody and their expert
opinions on how to prevent another crisis in the future.
Madam Chair, thank you for your indulgence, and I yield
back.
[The statement of Ranking Member Higgins follows:]
Statement of Ranking Member Clay Higgins
Jan. 14, 2020
Thank you, Madam Chair.
And thank you Chief Hastings and Doctor Eastman for your service at
the border and for being here today.
I look forward to hearing in greater detail about the actions DHS
has taken to enhance Customs and Border Protection's ability to handle
migrants arriving at our border in deteriorating health and to address
preventable deaths in custody
The crisis that unfolded along our Southwest Border last year was
not a fake emergency, it is not the fault of the men and women of CBP,
and it is not the fault of the President of the United States, Donald
Trump.
The truth is, this past year we saw record numbers of family units,
unaccompanied minors, large groups of 100 migrants or more--213 to be
exact, arriving at our border during the height of flu season and
during months of extreme heat. At the time, the Border Patrol was
referring 50 cases per day to medical providers.
The border crisis was the result of legal loopholes, activist
judges, and propaganda from criminal killers who smuggle and traffick
migrants for profit.
In 2014, under the Obama administration, the number of
unaccompanied minors encountered at the border was viewed as crisis-
level, leading to former DHS Secretary Jeh Johnson writing an open
letter to Central American parents telling them not to send their
children. It is clear corrective actions were not taken back then.
If that was a crisis, then there are no words for what we
experienced at the border during fiscal year 2019. Not only were more
than 321,000 minors encountered by CBP, family unit apprehensions were
up more than 590 percent in fiscal year 2019 than fiscal year 2014.
Throughout the crisis most CBP facilities were at or over capacity.
CBP personnel were working overtime and for more than a month--without
pay--to process the large groups. Resources were depleting at record
time as key personnel at the Department were furloughed.
Yet CBP law enforcement officers still scraped together money out
of their own pockets to buy toys and bring in extra supplies for the
migrants in their custody, many of them parents themselves.
CBP agents and officers, already short-staffed had to refocus their
mission from stopping gangs, drugs, murderers, rapists, and even known
or suspected terrorists to instead process and care for the hundreds of
thousands of people that arrived at our border without the appropriate
facilities, resources, and medical support staff to do so.
After a 35-day shutdown that began at the end of 2018, the Federal
Government reopened in January 2019 and the crisis continued. In light
of the growing issues related to the mass influx of migrants, President
Trump made an official request to Congress for supplemental funding for
the border. Two months went by before we sent that money to the field.
House Democrats blocked a vote on supplemental assistance more than 15
times. While House Democrat leaders were tweeting #FakeEmergency, the
chief of the Border Patrol was testifying in front of Congress that
without the funding, we may ``lose the border.''
The bipartisan Homeland Security Advisory Council released a report
on the crisis stating that the delay in passing the supplemental
resulted in unaccompanied minors being held in CBP facilities for
dangerous lengths of time.
There are Members on this committee who voted against the emergency
supplemental. A ``no'' vote meant a vote to keep unaccompanied minors
in CBP custody instead of at Department of Health and Human Services
facilities suitable for children. It meant releasing thousands of
migrants on the streets of border communities. Border county Sheriff
Napier testified before this committee that during the crisis, ``Social
service resources that should address local issues of hunger and
homelessness are now completely unable to do so.''
While the men and women of CBP were struggling to keep the lights
on at the border, they were the subject of partisan attacks. One Member
even claimed that the tragic deaths of children in custody were
intentional, an absurdity that was completely debunked last month as
the DHS Inspector General found no misconduct or malfeasance by DHS
personnel upon completion of investigations into the heartbreaking
deaths of Jakelin and Felipe in December 2018.
Every life is precious, and even 1 death in custody is 1 too many,
which is why I was encouraged to learn about the immediate steps CBP
took to enhance their ability to diagnose the health of migrants in
custody and work with the DHS chief medical officer to make needed
long-term improvements.
In December 2018, then-Commissioner Kevin McAleenan ordered
secondary medical checks on every child in custody and initiated an
internal evaluation of CBP care policies. Since then, CBP established a
phased approach to conducting health interviews of all migrants during
initial processing and a subsequent full medical assessment of all
minors and at-risk adults.
On top of that, CBP now has over 700 medical personnel and
contractors stationed across the Southwest Border to provide medical
support to migrants in custody.
Today, I would like to hear from our witnesses about how CBP's in-
custody medical capabilities have improved since fall of 2018, the
collaboration process between CBP, the Office of the DHS Chief Medical
Officer and other relevant stakeholders to bolster CBP's ability to
stop preventable deaths in custody, and their expert opinions on how to
prevent another crisis in the future.
Miss Rice. Thank you, Mr. Higgins. The Chair now recognizes
the Chairman of the overall Homeland Security Committee, the
gentleman from Mississippi, Mr. Thompson for an opening
statement.
Mr. Thompson. Thank you very much, Madam Chair. Good
morning to those of you who are here on the committee. Today's
hearing topic is sobering as it centers on the death of
innocent children. In our current hectic and rapidly-changing
political environment, it can be easy to move on quickly from
past disasters and tragedies. The Trump administration
contributes to this situation by piling scandal on scandal,
exhausting the public, the media, and the oversight
organizations.
It is our oversight responsibility, as Members of Congress,
to refuse to allow the most disturbing and upsetting events
fade into the past and help ensure that they are not repeated.
We are here today to examine the treatment of migrant children
in the custody of the Department of Homeland Security in 2018
and 2019, and look at what changes may still be necessary.
Certainly detention of migrants did not begin with the
current administration, but in earlier administrations, both
Democratic and Republican, officials took steps to avoid
risking the health and safety of the most vulnerable people in
custody.
Under the Trump administration, we now find the elderly,
the infirm, and children in detention facilities such as Border
Patrol stations, not designed or equipped to hold people for
extended periods of time. When arrivals at our Southern Border
began to rise sharply in 2018, the decision to detain everyone
led to severe overcrowding. The DHS Office of Inspector
General, attorneys, and Members of Congress, including me,
observed and reported on the conditions inside these facilities
for months.
CBP argued throughout this crisis that they faced severe
resource constraints, despite Congress providing billions in
humanitarian funding in early 2019. Standing-room-only cells,
inadequate hygiene products, and families kept outside in
extremely variable temperatures were commonplace at CBP
facilities during the height of migrant arrivals last year.
In such an environment, the spread of illnesses such as the
flu are inevitable. Whether individual deaths can be directly
attributed to specific conditions in a given facility or not,
we need to understand whether the policies and resource
management decisions made by the administration put lives in
jeopardy.
Congress cannot allow DHS and CBP leaders to make poor
decisions or ignore existing policies and law for purely
messaging reasons. Secure borders are a priority for our
country and for all of us on this panel and have been for
decades. Part of our responsibility as Members of Congress is
to check actions by the Executive branch that are misguided.
Hearings such as this are a critical part of that effort. I
have strong objections to the policies the Trump administration
has in place along our border that continue to endanger the
safety of migrant children such as Remain in Mexico.
I hope to hear from our DHS witnesses this morning that the
Department will take its responsibility toward people in its
custody more seriously going forward. One child death was one
too many. I am eager to know what the Department plans to do
differently in order to safeguard children's safety while in
DHS's custody.
I thank the Chairwoman and Ranking Member for holding
today's important hearing, and I yield back.
[The statement of Chairman Thompson follows:]
Statement of Chairman Bennie G. Thompson
January 14, 2020
Today's hearing topic is sobering, as it centers on the deaths of
innocent children. In our current hectic and rapidly-changing political
environment, it can be easy to move on quickly from past disasters and
tragedies. The Trump administration contributes to this situation by
piling scandal on scandal--exhausting the public, the media, and
oversight organizations. It is part of our oversight responsibility as
Members of Congress to refuse to allow the most disturbing and
upsetting events fade into the past and help ensure they are not
repeated. We are here today to examine the treatment of migrant
children in the custody of the Department of Homeland Security in 2018
and 2019, and look at what changes may still be necessary.
Certainly, detention of migrants did not begin with the current
administration. But in earlier administrations, both Democratic and
Republican officials took steps to avoid risking the health and safety
of the most vulnerable people in custody. Under the Trump
administration, we now find the elderly, the infirm, and children in
detention facilities, such as Border Patrol stations, not designed or
equipped to hold people for extended periods of time. When arrivals at
our Southern Border began to rise sharply in 2018, the decision to
detain everyone led to severe overcrowding. The DHS Office of Inspector
General, attorneys, and Members of Congress--including me--observed and
reported on the conditions inside these facilities for months. CBP
argued throughout this crisis that they faced severe resource
constraints, despite Congress providing billions in humanitarian
funding in early 2019. Standing-room-only cells, inadequate hygiene
products, and families kept outside in extremely variable temperatures
were all commonplace at CBP facilities during the height of migrant
arrivals last year. In such an environment, the spread of illnesses,
such as the flu, are inevitable.
Whether individual deaths can be directly attributed to specific
conditions in a given facility or not, we need to understand whether
the policies and resource management decisions made by the
administration put lives in jeopardy. Congress cannot allow DHS and CBP
leaders to make poor decisions or ignore existing policies and law for
purely messaging reasons. Secure borders are a priority for our
country--and for all of us on this panel--and have been for decades.
Part of our responsibility as Members of Congress is to check actions
by the Executive branch that are misguided. Hearings such as this are a
crucial part of that effort. I have strong objections to the policies
the Trump administration has put in place along our border that
continue to endanger the safety of migrant children--such as ``Remain
in Mexico.''
I hope to hear from our DHS witnesses this morning that the
Department will take its responsibility toward people in its custody
more seriously going forward. One child death was one too many. I am
eager to know what the Department plans to do differently in order to
safeguard children's safety while in DHS custody.
Miss Rice. Thank you, Mr. Chairman.
Other Members of the subcommittee are reminded that under
the committee rules, opening statements may be submitted for
the record.
I welcome the panel of witnesses. Our first witness, Mr.
Brian S. Hastings, is chief law enforcement operations, U.S.
Border Patrol, U.S. Customs and Border Protection, Department
of Homeland Security. Brian S. Hastings is the chief of the Law
Enforcement Operations Directorate at U.S. Border Patrol
headquarters in Washington, DC. He is responsible for oversight
of the day-to-day law enforcement operations at Border Patrol
sectors throughout the United States and a principal adviser to
the chief of the Border Patrol on enforcement operations. Chief
Hastings began his service with the Border Patrol in 1995 and
has been stationed in various sectors across all U.S. borders
and was promoted to the senior executive service in 2018.
Our second witness, Dr. Alexander L. Eastman, is the senior
medical officer for operations within the United States
Department of Homeland Security's Countering Weapons of Mass
Destruction Office. In this role, he is responsible for
operational medicine across DHS in addition to countering
threats to the United States world-wide.
Previously Dr. Eastman served as the chief of the Rees-
Jones Trauma Center at Parkland Memorial Hospital and as an
assistant professor and trauma surgeon in the division of
burns, trauma, and critical care at the University of Texas
Southwestern Medical Center. Dr. Eastman is also a decorated
police officer within the Dallas Police Department.
Without objection, the witnesses' full statements will be
inserted in the record. I now ask each witness to summarize his
statement for 5 minutes beginning with Mr. Hastings.
STATEMENT OF BRIAN S. HASTINGS, CHIEF, LAW ENFORCEMENT
OPERATIONS DIRECTORATE, U.S. BORDER PATROL, U.S. CUSTOMS AND
BORDER PROTECTION, U.S. DEPARTMENT OF HOMELAND SECURITY
Mr. Hastings. Good morning, Chairman Rice, Ranking Member
Higgins, and Members of the subcommittee. As part of CBP's
mission to safeguard America's borders, we complete initial
processing of individuals in our custody before transferring
them on our partners. While our holding facilities were
designed for only short-term custody, we take seriously our
responsibility to protect and care for individuals until they
can be transferred.
During fiscal year 2019 CBP apprehended or found
inadmissible more than 1.1 million people. In December 2018, we
began alerting Congress, the media, and the public that an
unprecedented spike in Central American families and children
was creating a crisis on our Southern Border. For months, our
requests for immediate legal and emergency funding went
unanswered, and we began diverting resources from our border
security mission to address the crisis.
As I prepared to testify before you today, I reflected on
the numerous actions CBP has taken and continues to take in
response to this crisis. I could not be more proud of the
extraordinary efforts undertaken by the men and women of CBP. I
would like to share with you many examples today of the
challenges we face and our rapid actions to address them.
First, as the apprehensions skyrocketed, we had more people
in our custody than we could quickly process. We continued to
prioritize processing of the UACs first, followed by families,
and then single adults. CBP surged more than 1,050 officers and
agents to the busiest sectors. As many as 40 to 60 percent of
our agents were diverted from securing the border to caring for
those in our custody.
Over 700 DHS personnel provided support at our facilities.
We expanded our transportation contract and purchased more than
200 buses and vans to expedite transportation of large groups
of migrants. We chartered planes and drove busloads of more
than 43,000 people from overwhelmed locations to facilities
with more processing capacity.
Second, even when processing was complete, ICE and HHS had
limited capacity to accept aliens, which contributed to further
overcrowding in Border Patrol facilities. In March 2019, Border
Patrol began releasing noncriminal family units directly into
the United States rather than transferring them to ICE. During
fiscal year 2019 a total of 145,000 family members were
released. CBP rapidly constructed 6 soft-sided facilities that
provided capacity for an additional 6,500 families and adults.
By June, Secretary Azar stated HHS shelters were full and
they could not accept UACs from Border Patrol custody. When HHS
received supplemental funding in July, the number of UACs in
our custody quickly dropped from a peak of 2,700, down to 300.
Third, we addressed the need for amenities that our short-
term holding facilities were not designed to provide. We
outfitted the new soft-sided facilities and our highest-volume
stations with portable showers, toilets, sinks, laundry,
climate control system, and kitchen equipment. We expanded our
food service contract to provide millions of meals and stock
countless snacks, water bottles, clothing, and hygiene items.
Finally, we accelerated the expansion of our medical
support program. CBP issued interim medical directive in
January 2019, which was superceded by an enhanced medical
directive in December. This directive sets forth foundational
levels of medical support for CBP.
It utilizes a phased approach through initial observations,
medical interviews with a standardized health questionnaire,
and medical assessments to identify potential medical issues
and low acuity treatment.
In the last year, CBP has dramatically increased the number
of contract medical professionals to more than 700. Where we
built this capacity, U.S. Coast Guard and Public Health
Services medical personnel were dispatched to many of our
facilities. Now on any given day, approximately 300 contract
medical personnel are engaged at more than 40 facilities along
our Southwest Border, providing 24/7 on-site medical support.
Our medical support follows a family practitioner model
which has been observed and validated by medical experts. This
model ensures our medical providers are trained, licensed, and
credentialed to care for all populations in our custody,
including children and pregnant women.
Physicians, to include pediatricians, provide oversight in
training, consultation for medical direction, and medical
quality management. On-site medical personnel may provide care,
write prescriptions, or recommend advanced care in the local
health care system.
In the last year, nearly 250,000 juveniles and more than
296,000 adults have received medical interviews. Nearly 60,000
juveniles and more than 95,000 adults have received medical
assessments. During fiscal year 2019, Border Patrol took a
total of 26,000 people to a hospital or a medical facility when
advanced care was needed or requested. Agents spent more than
319,000 hours providing transportation to and from medical
facilities and on hospital watch.
Today with the help of our interagency partners and our
governmental partners in the hemisphere, we have effectively
ended catch-and-release at the border. The flow of aliens has
dropped by 72 percent. However, these initiatives, like the
supplemental funding, are only temporary fixes. As we have said
many times before, Congress must close the loopholes in our
Immigration Service system that serve as pull factors. Or we
risk returning to or exceeding peak levels and overwhelming our
immigration system yet again.
Thank you and I look forward to your questions.
[The prepared statement of Mr. Hastings follows:]
Prepared Statement of Brian S. Hastings
January 14, 2020
Chairwoman Rice, Ranking Member Higgins, and Members of the
subcommittee, I appear before you today to discuss the actions that the
Department of Homeland Security (DHS) and U.S. Customs and Border
Protection (CBP) have taken to ensure all people in our custody--
especially children--receive the care they need for the short time they
are in our custody before entering the U.S. immigration system.
cbp's law enforcement mission
CBP is a Federal law enforcement agency, yet it has a unique role.
CBP bears the responsibility of serving as the front-line defense along
the Nation's borders. CBP is responsible for protecting the public from
dangerous people and materials, while simultaneously facilitating
legitimate international travel and trade.
The men and women of U.S. Border Patrol (USBP), Office of Field
Operations (OFO), and Air and Marine Operations (AMO) go to work each
day not knowing who the next person they encounter will be: An armed
criminal, a narcotics smuggler, an individual with ties to terrorism,
an adult seeking a better life, or--as has increasingly been the case
over the past year--an innocent child. In our unique law enforcement
role, CBP must be ready to respond to any situation at any time.
Every day, our law enforcement personnel arrest individuals for a
wide variety of criminal and immigration law violations. When we arrest
an individual, he or she is booked into our systems; the appropriate
biometrics are collected and record checks are run; then agents and
officers begin to process the individual through the appropriate
pathways in the U.S. criminal justice and immigration systems,
depending on the individual circumstances.
As is the case for nearly every police station across the country,
CBP's facilities along the border and at ports of entry (POEs) are
designed to serve as short-term holding areas for those in our custody
to undergo this initial processing. At the earliest opportunity, we
notify and arrange a transfer of custody to the appropriate Federal
agency.
the humanitarian crisis of fiscal year 2019
During fiscal year 2019, CBP apprehended or found inadmissible more
than 1.14 million individuals. Eighty-five percent of those
encounters--more than 977,500--occurred on the Southwest Border, an
average of nearly 2 apprehensions or findings of inadmissibility every
minute of every day for the entire year.
Because the majority of illegal entries occur between the ports of
entry, USBP apprehensions account for the majority of the people
illegally crossing the 2,000-mile border with Mexico. During fiscal
year 2019, USBP Southwest Border apprehensions exceeded 851,000--the
highest level since fiscal year 2017. Nearly 65 percent of USBP
apprehensions were families and children--more than 473,000
individuals--the highest number of family units in any year on record
and an increase of 342 percent over the previous record. Unaccompanied
alien children (UAC) apprehensions also increased by 52 percent
compared to the previous year. In total, USBP processed more than
321,000 alien children on the Southwest Border during fiscal year 2019.
At the peak of the crisis in May 2019, USBP apprehended nearly
133,000 people in a single month. Between January and May, both single
adult and UAC apprehensions doubled while family unit apprehensions
more than tripled. On a single day in May 2019, USBP apprehended more
than 5,500 people on the Southwest Border, including more than 1,000
who illegally entered the United States as a single group. This influx
led to CBP facilities operating at unprecedented and unsustainable
occupancy levels.
CBP's ability to transfer people out of its custody depends on the
capacity of our partners at U.S. Immigration and Customs Enforcement
(ICE) and the U.S. Department of Health and Human Services (HHS). These
and other agencies are able to determine when they accept custody of
individuals from CBP; as such, they have a level of flexibility that
CBP does not. CBP must process individuals as they are apprehended and
maintain custody until our partners can accept custody of them.
In areas of high rates of illegal entry, many Border Patrol
stations were unable to efficiently process individuals due to
exceedingly high volume. To address this shortfall, CBP temporarily
detailed more than 730 CBP officers and more than 320 USBP agents from
around the country to augment its operations in these locations. In
addition, DHS surged more than 700 personnel from other components to
serve in general support and medical support functions, including U.S.
Coast Guard, Federal Protective Service, and the Federal Air Marshals
Service. These volunteers assisted with functions such as personal
property management, meal service, welfare checks, and transportation
support.
CBP continued its long-standing practice of prioritizing the
processing of UACs, followed by families, then single adults. In
addition, CBP partnered with ICE to transport family units by plane or
bus to other parts of the border to expedite processing. However, as
processing times decreased, ICE and HHS began struggling to keep pace
with USBP apprehensions, and the backlog of family units and UACs in
USBP custody continued to swell.
Beginning in March 2019, Border Patrol stations released family
units directly into the United States to reduce overcrowding. Rather
than being transferred to ICE's limited bed space at family residential
facilities, more than 145,000 individuals in family units were released
on their own recognizance for a later appearance in immigration court.
Non-governmental organizations that provided post-release support in
border communities soon began experiencing their own overcrowding
issues. In contrast to family units, UACs could not be released into
communities. Under the Trafficking Victims Protection Reauthorization
Act of 2008 (TVPRA), CBP generally must transfer custody of UACs to HHS
within 72 hours.
Border Patrol stations were not designed to hold large volumes of
apprehended aliens or for their long-term custody after processing is
complete. Beginning in February 2019, to accommodate the growing number
of people in custody, USBP diverted operating funds to rapidly
construct 6 soft-sided facilities in the Rio Grande Valley, El Paso,
and Yuma Sectors. The temporary structures are weatherproof, climate-
controlled, and provide areas for eating, sleeping, recreation, and
personal hygiene. They include shower trailers, chemical toilets and
sinks, laundry trailers, sleeping mats, personal property storage
boxes, lockers, power, kitchen equipment, food/snacks/water, clothing
and hygiene kits, and space for medical assessment and treatment.
Additionally, since the beginning of the crisis, USBP invested over
$230 million in humanitarian support, to include consumables such as
meals, snacks, baby formula, shampoo, diapers, and other hygiene items;
enhanced medical support; and increased transportation services.
emergency humanitarian supplemental appropriation
On May 1, 2019, the administration submitted a request to Congress
for emergency supplemental funding for CBP, ICE, and HHS to address the
crisis. The Emergency Supplemental Appropriations for Humanitarian
Assistance and Security at the Southern Border Act, 2019 was signed
into law on July 1, 2019, providing $4.6 billion in supplemental
funding.
This bill provided CBP with $1.1 billion for humanitarian support,
border operations, and mission support. To enhance humanitarian support
efforts, CBP purchased food, water, sanitary items, blankets, medical
support, and other consumables with these funds; in addition, 462
additional shower stalls, 79 additional portable toilets, 6 additional
laundry trailers, 51 commercial washer-dryer sets, 90 refrigerators and
freezers, and 200 climate control systems were procured. CBP also
purchased additional transportation assets including buses, vans, and
Emergency Medical Technician (EMT) vehicles.
Border operations funding was utilized for overtime and temporary
duty assignments for USBP agents and CBP officers as well as costs
associated with the DHS volunteer surge force. These supplemental funds
enabled the replenishment of operational funds previously expended on
soft-sided facilities and humanitarian investments. Without the
supplemental appropriation, the funding for our humanitarian efforts
would have been exhausted before the end of the fiscal year. Funds were
also provided for modernized data systems to better integrate
immigration processing and reporting by the DHS, HHS, and the
Department of Justice.
Our partners at HHS received $2.9 billion in the supplemental
appropriation, which funded additional HHS shelters and beds, allowing
for more expeditious processing and transport of UACs from CBP custody
to facilities designed for the long-term care of children. As a result,
the number of UACs in USBP custody at any one time dropped from the
peak of nearly 2,700 in early June 2019 to around 300 in July 2019.
ICE bed capacity shortfalls limited CBP's ability to transfer
single adults to facilities designed for long-term custody. As a
result, USBP experienced a higher volume of single adults in custody
for longer periods of time. From May through July 2019, USBP
continually averaged more than 6,550 single adults in custody at any
given time. While DHS requested $108 million for beds at ICE detention
facilities, this provision was not funded.
enhanced medical care
The recent humanitarian and security crisis along the Southwest
Border created a significant challenge for CBP. The agency was charged
with addressing medical support requirements for the increased number
of people in custody, including children and family units. CBP
recognized the operational and medical importance of prioritizing the
expansion of medical support along the Southwest Border and remains
committed to ensuring that people in CBP custody receive appropriate
medical support. CBP has taken steps to significantly enhance our
medical support program, consistent with our core law enforcement
mission.
Following the surge in UAC encounters during 2014, CBP established
a contract for on-site medical support in the busiest sector, Rio
Grande Valley. In the summer of 2018--prior to the tragic deaths of 2
Guatemalan children in December 2018--CBP expanded the medical support
contract to additional priority locations in the Laredo, El Paso, and
Yuma sectors. CBP continued to enhance and expand medical support
throughout 2019, dramatically increasing the number of contracted
medical professionals from approximately 20 in January 2019 to more
than 700 today. Currently, each day, there are approximately 300
contracted medical professionals engaged at more than 40 facilities
along the Southwest Border, providing 24/7 on-site medical support.
Support is now available at all 9 Southwest Border USBP sectors and all
4 Southwest Border OFO field offices.
CBP recognizes the unique challenges of providing medical support
to children in custody, and has extensively consulted with internal and
external pediatric subject-matter experts, including multiple HHS
pediatricians and other senior U.S. Government pediatric care experts.
CBP has also collaborated with court-appointed pediatric consultants to
inform CBP's approach to care for children in custody, and contracted
regional pediatric advisors to provide advice, training, review,
coordination, and quality management of CBP pediatric care efforts.
CBP's medical services contract employs medical teams, consisting
of Advanced Practice Providers and medical technicians, to provide
round-the-clock medical support at priority locations. These medical
providers are licensed and credentialed to provide assessment and care
for our population in custody, to include children and pregnant women.
This model, a family practitioner model that pairs advanced
practice providers such as Physician Assistants or Nurse Practitioners
with medical support personnel at CBP facilities, has a layer of
supervisory physician-level oversight both regionally and nationally
for medical direction and records review. This model has been observed
and validated by medical experts including top pediatricians within
HHS, who have indicated it provides the appropriate care and scope of
practice for CBP facilities. It also directs development of appropriate
medical quality-management efforts, in consultation with the CBP chief
medical officer, Office of Chief Human Capital Officer, and the DHS
chief medical officer, as well as accountability through the Management
Inspection Division and the Juvenile Coordinator.
As noted in the above, CBP utilizes a layered approach to medical
support for people in custody. CBP relies heavily on local health
systems and local standards of care, referring and transporting people
with complex, urgent, or emergent health issues to local hospitals or
medical facilities. CBP often operates in remote and austere areas
where there are limited medical facilities. In these areas, USBP agents
and CBP officers are often the first responders to a person in need of
medical attention. More than 1,200 USBP agents and 275 CBP officers
have voluntarily taken on the additional responsibilities and training
required to maintain EMT or paramedic certifications as a collateral
duty. In fiscal year 2019 alone, USBP agents rescued more than 4,900
migrants in distress along the border after they were placed in
dangerous situations by smugglers. In addition, USBP referred more than
26,000 people to hospitals or medical facilities.
Additionally, CBP relies upon our partners at ICE and HHS who have
more robust medical capabilities in alignment with their respective
missions. Medical services, such as vaccinations and convalescence
centers, are better provided in shelter care environments such as those
provided by HHS and long-term detention environments provided by ICE.
CBP is proud of the great strides we have made in providing
critical and life-saving medical support to those in need while
remaining cognizant that we are a frontline law enforcement element
within a broader network of immigration agencies.
Enhanced Medical Support Directive
In January 2019, CBP issued an Interim Enhanced Medical Directive,
which established initial priority approaches to enhancing CBP medical
care for people in custody. On December 30, 2019, CBP issued an
Enhanced Medical Support Directive as part of an overarching medical
support construct involving a dynamic process of constant review and
improvement. This directive was developed using operational and medical
lessons learned, and with significant stakeholder and medical expert
input.
The Enhanced Medical Support Directive outlines the
responsibilities and procedures for both USBP and OFO in how they will
deploy enhanced medical support efforts to mitigate health risks to
those in custody. This effort aligns USBP and OFO medical support
efforts, but is subject to resource availability and operational
requirements. The Directive provides top-level guidance and is
intentionally flexible, to facilitate modifications in alignment with
changing conditions. Furthermore, it establishes foundational levels of
medical support, although in many cases, CBP already exceeds these
levels. It enhances processes established last year and provides clear
direction for USBP and OFO for establishing an on-going contract
mechanism to support enhanced medical support along the Southwest
Border.
The Enhanced Medical Directive ensures that CBP will sustain
enhanced medical support capabilities with an emphasis on children less
than 18 years old. These include a health interview upon initial
arrival at a CBP facility. The interviews will be conducted by
contracted medical personnel or by CBP agents/officers using a
standardized health form. Subject to resource availability, USBP and
OFO will ensure a more detailed medical assessment is conducted on all
tender-age (12 and under) children, any person with a positive response
to mandatory referral questions on the health interview form, or any
other person with a known or reported medical concern. The medical
assessments will be conducted by CBP contracted health providers where
available, or, when appropriate, the individual will be referred to the
local health care system/providers. CBP EMT-certified agents and
officers will conduct medical assessments only in exigent circumstances
and when operationally available.
Infectious Disease
CBP works closely with State, local, and Federal public health
officials regarding public health and infectious disease issues. CBP
continues to engage in extensive dialog and consultation with numerous
stakeholders who have provided subject-matter expert consultation,
including DHS, U.S. Coast Guard medical leadership, HHS, and the
Centers for Disease Control and Prevention.
CBP-contracted medical personnel are trained to provide early
identification, treatment, isolation, infection control, and public
health support for infectious diseases in CBP facilities. For example,
CBP's on-site contracted medical teams provide early identification and
diagnosis via rapid flu testing; they can also provide antiviral
treatment and prophylaxis on-site. Furthermore, they have the ability
to enact enhanced prevention and control measures, and referrals to
hospitals and emergency rooms if necessary.
CBP's medical capabilities are part of a larger system of care for
migrants in Government custody. CBP ensures that individuals in our
custody receive the appropriate medical care during the short time they
are in our custody; however, longer-term facilities at ICE and HHS have
the resources and facilities to provide necessary comprehensive medical
care, including vaccinations.
the crisis is far from over
As a result of multiple whole-of-Government initiatives to expedite
immigration hearings, repatriate individuals ordered for removal, and
effectively end the release of migrants directly from the border,
Southwest Border apprehensions have dropped by 75 percent since May
2019. Word of mouth, including the use of social media and other
internet-based applications, which had been used to encourage,
organize, plan, and initiate mass immigration from Central America, is
now informing prospective migrants that they can no longer rely on
being released once they get here.
The reduced migration flows have begun to alleviate the stress on
our system that the crisis created. Many of the improvements made to
address the crisis relied on the influx of emergency supplemental funds
that do not last forever. Similarly, these new initiatives rely heavily
on partnerships with Mexico and Central American nations. Neither
address the fundamental flaws in our immigration system. For more than
a year now, CBP has pleaded with Congress to address the layers of
existing law and judicial decisions that adversely impact our ability
to effectively manage our immigration system. There are 3 key gaps in
our legal framework that Congress has yet to address.
First, the 1997 Flores Settlement Agreement requires the Government
to transfer alien minors to non-secure, licensed programs ``as
expeditiously as possible'' and, if detention is not required, release
alien minors from detention without unnecessary delay. Soon after the
2014 surge in UACs along the Southwest Border, the U.S. District Court
for the Central District of California reinterpreted the Flores
Settlement Agreement as applying not only to minors who arrive in the
United States unaccompanied, but also to those children who arrive with
their parents or legal guardians. In other words, the U.S. District
Court for the Central District of California applied the Flores
Settlement Agreement to all children in our custody. The court also
determined that ICE's family detention facilities are not licensed and
are secure facilities. As a result of this case and others like it,
DHS's ability to detain family units for the duration of their
immigration proceedings is limited, in that DHS rarely detains
accompanied children and their parents or legal guardians for longer
than 20 days.
Second, the TVPRA requires that the U.S. Government extend certain
protections to UACs. Specifically, the TVPRA requires that, once a
child is determined to be a UAC, the child must be transferred to HHS
custody within 72 hours, absent exceptional circumstances, unless the
child is a National or habitual resident of a contiguous country and is
determined to be eligible to withdraw his or her application for
admission voluntarily (i.e., not a trafficking victim, does not have a
fear of return, and is able to make an independent decision to
withdraw). UACs from countries other than Canada and Mexico are not
permitted to withdraw their application for admission and thus, cannot
be quickly returned to their country of origin. During fiscal year
2019, 79 percent of the UACs apprehended by USBP on the Southwest
Border originated in Guatemala, Honduras, and El Salvador.
Third, CBP has seen a significant increase in the number and
percentage of people who seek admission without proper documentation or
unlawfully enter the United States then assert an intent to apply for
asylum or claim a fear of persecution on account of race, religion,
nationality, membership in a particular social group, or political
opinion. This dramatic increase is due in part to the systemic
deficiencies created by the ineffective legal standards--again, further
straining border security resources, immigration enforcement and
courts, and other Federal resources.
conclusion
DHS and CBP remain committed to ensuring that individuals in CBP
custody receive appropriate care, including medical support, but these
efforts do not address the on-going challenges we face. Once again, we
urge Congress to take a comprehensive look at the immigration laws and
the implications from those court decisions that shaped immigration
laws. Real change requires real reform.
Thank you for the opportunity to testify before you today. I look
forward to your questions.
Miss Rice. Thank you for your testimony. I now recognize
Dr. Eastman to summarize his statement for 5 minutes.
STATEMENT OF ALEXANDER L. EASTMAN, M.D., MPH, FACS, FAEMS,
SENIOR MEDICAL OFFICER--OPERATIONS, COUNTERING WEAPONS OF MASS
DESTRUCTION OFFICE, U.S. DEPARTMENT OF HOMELAND SECURITY
Dr. Eastman. Good morning, Chairwoman Rice, Ranking Member
Higgins, Chairman Thompson, distinguished Members of the
subcommittee and guests. It is an honor to be here today to
discuss the Department of Homeland Security's efforts to
prevent child deaths in custody through our provision and
expansion of medical care during the recent migration crisis.
I am Dr. Alex Eastman, the senior medical officer for
operations at DHS. I have been a practicing physician for
nearly 20 years, and in addition to my role here at DHS,
continue to be a practicing trauma surgeon and surgical
intensivist.
Immediately prior to coming to DHS, I was the chief at the
Rees-Jones Trauma Center at Parkland Memorial Hospital in
Dallas, Texas. At Parkland, we cared for human beings from all
backgrounds in their most desperate time. You care for everyone
without regards to race, color, creed, means, religion. Quickly
it becomes apparent that when life and death are on the line,
none of these things matter. Providing care for patients, no
matter the challenges, was my goal then and is our goal now.
From all your visits to the border--and it is nice to see
you all again this morning--I know you are aware that we
continue to improve the care for all people in our custody,
especially children.
From the medical perspective, the crux of this humanitarian
crisis was a massive increase in the potential demand for care,
at times nearly 400 percent, a number that would gridlock any
conventional health care system.
Additionally, while correctional facilities have embedded
detainee health care systems, law enforcement agencies do not.
CBP is primarily a law enforcement organization, never designed
to have a health care system within its walls. Doing so would
be akin to building a minute clinic in every police station in
America.
Yet our challenge in the midst of this crushing demand, was
an unconventional problem that required an unconventional
solution--to help CBP and our other DHS components rise to the
task of providing care to an overwhelming number of people,
including children, in our custody.
The expansion to where we are today, the system currently
in place, and the direction we are headed, represents a
Herculean effort in response to an unprecedented challenge. In
December 2018, the DHS Secretary directed the provision of
immediate assistance with the rising humanitarian demands of
the migration crisis.
We immediately deployed, and for the last 13 months, have
been working on the border, alongside colleagues from CBP, ICE,
Federal agencies like HHS and CDC, as well as State and local
public health, medical experts and professionals to improve the
care of migrants in custody, with particular attention to the
children and the most vulnerable adults the law directs us to
hold.
Our first priority was to rapidly and urgently expand our
medical capabilities along the Southwest Border, particularly
at CBP which had the biggest need. In support of this mission,
the United States Coast Guard deployed more than 30 teams to
the Southwest Border providing more than 3,450 medical officer
days and more than 8,275 health service technician days of care
in the rapid response to this crisis.
The Coast Guard served as our lifeline, our immediate
response force from a medical standpoint. America should be
grateful for the truly life-saving and timely work of the Coast
Guard during this crisis as well as so many others.
DHS also received critical assistance from the United
States Public Health Service. Our Nation's Assistant Secretary
for Health, Admiral Brett Giroir, himself, a pediatrician and
intensivist, was a critical partner as we facilitated the
targeted deployment of Public Health Service officers to
critical areas along the Southwest Border.
There were more than 475 Public Health Service officers
deployed to the border, totaling more than 6,750 days of care
provided to migrants. No mission was too difficult, including
even loading into helicopters and going to our most remote
border regions to immediately begin assessing migrants and
providing any care necessary as early as possible.
When large groups overwhelmed us in areas without Public
Health Service or Coast Guard assistance, we moved them there.
These two organizations gave so freely of their time and
expertise. The officers, and physicians, and nurses who came
down saved lives directly and continue to do so with the legacy
they have left along the Southwest Border.
As the interagency was countering the crushing surge, CBP
was diligently working to build the system that would assume
care from the emergency responders. As mentioned, that system
now includes, among other aspects, more than 700 contracted
providers, enhanced countermeasures for influenza and other
infectious disease, and a medical directive that begins to lay
out the path forward to continue the iterative process that
allows the system to evolve as required.
Our approach to improve care has been collaborative, not
just by coordinating with Federal interagency partners but also
by building and continuing critical State and local
partnerships, collaborating with the Mexican government, and
calling upon non-Government experts to assist when needed.
Several systematic reviews of this developing system have been
undertaken in the last year, all agreeing that the approach is
sound.
We have a legal, moral, and ethical duty to care for those
in our custody. The challenge was unprecedented, required an
unconventional solution, and we responded.
At DHS and across the Government, we remain committed to
ensuring that individuals, especially our children, receive
appropriate medical care.
Thank you very much, and I look forward to answering your
questions.
[The prepared statement of Dr. Eastman follows:]
Prepared Staement of Alexander L. Eastman
January 14, 2020
Chairwoman Rice, Ranking Member Higgins, and Members of the
subcommittee: Thank you for the opportunity to appear before you today
to discuss DHS's medical care of children during the recent migration
crisis. As you are aware from this committee's many visits to the
United States Southwest Border (SWB), the medical care of children in
DHS custody does not occur in a vacuum. It is a system that is
complicated, involves many other U.S. Government departments, and is
evolving as we speak. Additionally, while the focus of this hearing is
on the care of children, we have one system that cares for both adult
and children in our custody and hence, at times, we'll discuss both.
From a global ``strategic'' standpoint, our approach is to ensure that
all persons in DHS custody, whether children or adults, receive the
right medical care, at the right time, at the right place in this
complicated, custodial health care system. On behalf of Chief Medical
Officer Duane C. Caneva and the Countering Weapons of Mass Destruction
Office (CWMD), where the Office of the Chief Medical Officer resides,
we are committed to not only implementing this strategy but making sure
the system improves daily.
cwmd/cmo support to the southwest border migration crisis
In late December 2018, Secretary Nielsen asked for immediate
assistance with the developing crisis along the SWB. Our full attention
turned to the border crisis, and we deployed experts to assist both
U.S. Customs and Border Protection (CBP) and U.S. Immigration and
Customs Enforcement (ICE) with health/medical/public health issues. As
directed by the Secretary, our priorities were:
(1) Eliminate preventable deaths related to the migration crisis
along the SWB;
(2) Ensure the integrity of our bio-surveillance system with
regards to protecting the United States from an intentional attack or
the unintentional risk from an infectious or communicable disease; and
(3) Provide the best possible, humanitarian medical care to those
in U.S. Government custody along the SWB.
During the past 13 months, CWMD has prioritized its limited
resources, personnel, and time to accomplish each of these goals.
cwmd direct support to the swb
Faced with the rising humanitarian demands of the migration crisis,
and particularly the increasing numbers of children being brought to
the United States as part of this crisis, members of CWMD staff
deployed immediately to the SWB to assist with coordination of health
care and public health response to meet the goals set by the Secretary.
CBP provides critical law enforcement functions at our Nation's
borders. Migrants taken into CBP custody generally are held in CBP
custody for the short period of time required for processing, and then
generally transferred to other components of the Department or
interagency systems that have the appropriate facilities and carry out
more robust health care functions. However, as the numbers of migrants,
particularly family units and children, were overwhelming the system's
capacity and increasing medical and public health risk, core staff were
deployed to the SWB to assist with development and coordination of the
medical response to this humanitarian crisis.
During the winter of 2018 and into the spring of 2019, we spent
significant time focused on coordinating an interagency medical surge
response, first with providers from the United States Coast Guard
(USCG), and then with critical assistance from the United States Public
Health Service (PHS), all while ensuring close coordination with State
and local Public Health Offices and private-sector health care systems.
CWMD medical and public health staff assisted with the response
coordination, helped the U.S. Border Patrol determine critical needs
and coordinated interagency efforts to respond to remote areas where
large numbers of migrants were apprehended outside of the developing
CBP network of contracted medical support. During the first 6 months of
the SWB migration crisis, the USCG deployed 34 independent teams to the
SWB. These teams, consisting of one medical officer and two corpsmen,
provided 3,468 medical officer days and 8,296 Health Service Technician
days of care at the most vital time in this response to this crisis.
Our Nation's Assistant Secretary for Health, ADM Brett Giroir, a
pediatric intensivist, was a critical partner as we deployed and placed
PHS Officers in Border Patrol Stations along the SWB. As CBP determined
its needs and which of its facilities were in critical need of medical
support, we facilitated the targeted deployment of PHS officers to
those critical areas. At times, in response to critical and emergent
operational needs, PHS Officers were flown to remote areas of the SWB
aboard CBP aircraft to begin triage and treatment of large migrant
groups immediately after apprehension. From December 30, 2018 through
October 2, 2019, there were 483 United States PHS officers deployed to
the SWB, totaling 6,759 days of care provided to migrants.
unaccompanied alien children and family units: a unique challenge to
the swb healthcare ``system'' and the overall 2019 migration crisis
As described in the CBP testimony submitted for this hearing, the
preponderance of unaccompanied alien children (UACs) and family unit
aliens (FMUAs) presented us with unique challenges that the existing
SWB health care infrastructure was unequipped and unprepared to deal
with. Relatively early in the crisis, at the request of the CBP acting
commissioner, CWMD employed the services of an experienced, senior
pediatrician from Columbia University to serve as our Senior Medical
Advisor for Pediatrics. In addition, we consulted and engaged with a
variety of other pediatric and health care experts, who made
recommendations and helped us shape our on-going efforts with regards
to the medical care of children caught in this crisis. Many of these
experts came to the SWB to directly observe the conditions and
subsequently used these visits and information to provide us with their
advice on how to best continue to shape and improve the care of
children in custody.
specialized expertise: available 24/7, every day
High-quality EMS medical direction and highly functioning EMS
systems provide the ability for EMTs and paramedics to reach physician
expertise. Early in the SWB migration crisis, focused on DHS EMTs and
paramedics but available to any of our medical providers, we recognized
the need for a provider involved to have the capacity to be in contact
with medical experts especially in the provision of care in austere
environments. Established in early 2017, and enhanced for this crisis,
we ensured that all DHS EMS and medical providers had the ability to
reach the DHS medical officer on-call. Originally requiring a phone
call, we expanded this capability to include the ability to reach out
via nearly any communication method utilized by DHS LEO EMTs and
paramedics. Integrated with the National Law Enforcement Communications
Center (NLECC, aka ``Sector''), from nearly anywhere in the world, our
providers are now available to contact 1 of our DHS EMS physicians at
all times.
consultation, coordination, and integration of an interagency effort
In addition to the direct operational medical support and pediatric
guidance described above, we coordinated and consulted with a variety
of medical experts to ensure that our practices met the most
appropriate tenets of quality medical care given the operational
constraints. The following individuals or organizations, inside and
outside of DHS, were consulted, formally visited the border, or were
hired to give their recommendations/evaluations of our practices during
the crisis:
(1) Centers for Disease Control and Prevention
a. Influenza Division
b. Division of Global Migration and Quarantine
(2) Chief Medical Officer, USCG
(3) Assistant Secretary for Preparedness and Response, U.S.
Department of Health and Human Services (HHS)
(4) Assistant Secretary for Health, HHS
(5) Senior Medical Advisor for Pediatrics, DHS.
As the response effort grew and encompassed the Federal
interagency, coordination structures for these efforts leveraged a
Unified Coordination Group structure, which included representatives
from the appropriate interagency members, established data collection
and analysis requirements, and refined thresholds for further action.
In addition to the above, CBP's Senior Medical Advisor has continuously
engaged with the court-appointed pediatric consultant to inform CBP's
approach to care for children in custody.
integration into local swb communities: critical linkages with health
care systems and public health
While the response to this unprecedented humanitarian migration
crisis is clearly Federal, much of the health and public health efforts
lie at the feet of our State and local health department and private-
sector health care partners. Hence, efforts for more deliberate State
and local public health engagement were reinstituted in the spring of
2018 and included regular conference calls, presentations at National
conferences, and face-to-face meetings. Regular coordination calls and
synchronization meetings with the 4 SWB States were started in October
2018 and covered DHS operational component updates, disease
surveillance updates, and feedback. At the peak of the crisis in the
spring of 2019, these conference calls had more than 250 invited,
regular participants from along the SWB. The calls continue today,
though are now held monthly or as necessary. Topics covered include
coordination on preparedness and response to disease outbreaks or
public health emergencies, investigation of potential infectious
disease outbreaks and those migrants that may have been effected,
discussions with operational components on issues related to detainee
transfer and release, consultation on Non-Government Organization
shelters in their States, and on-going public health engagement to
address specific public health issues including disease surveillance,
disease outbreak preparedness and response coordination, information
sharing, and general health care issues of concern locally. In addition
to these critical coordination calls, members of CWMD staff held, and
continue to hold, in-person visits and coordination meetings with State
and local public health officials from the State to the individual
community level in Texas, New Mexico, Arizona, and California.
improved coordination and integration of a swb health care system
After nearly 6 months of responding to the humanitarian crisis
response at the SWB, it was clear that this unconventional health care
infrastructure developing in CBP to urgently to meet unprecedented
demand required better integration and coordination. CBP is distinctly
different than ICE and HHS that have developed and embedded health care
systems. The CBP health care infrastructure is complicated by vast
geography, an international nexus, and the varying roles of multiple
departments and agencies of the U.S. Government. Recognizing this, CWMD
and CBP have identified the need to develop systems of coordination
jointly. This work is on-going at present. From an overall DHS SWB
health care architecture, close coordination of health care systems
along the SWB, including ICE Health Service Corps, CBP contract
services, HHS Office of Refugee Resettlement Agency for Children and
Families (ORR ACF), and local health care systems continues to
represent a significant challenge that we work to address daily.
international engagement
International engagement with the Government of Mexico's Ministry
of Health began informally with a meet-and-greet visit. Regular updates
of conditions across the border were provided from Department of State
partners from U.S. consulates near the border and through HHS
international offices. As result of these initial meetings, and
concerns expressed along both sides of the SWB, we organized a multi-
agency delegation that visited Mexico in May and outlined a path
forward to identify U.S. Government leads and partners for on-going
engagement. The delegation identified issues and outlined solutions to
ensuring migrant access to medical care, sharing information on disease
surveillance, options for medical records, and vaccination strategy
options. The visit also included meetings with international NGO's
operating to assist the migrant population in Mexico and hearing their
observations and concerns. The binational engagement occurs through
three international agreements already in place. The Binational
Technical Working Group (CDC leads) shares epidemiology trends along
the SWB at the local and State level, coordinating disease surveillance
and outbreak investigations. The North American Plan for Animal and
Pandemic Influenza (NAPAPI) Health Security Working Group (ASPR leads)
is a tripartite agreement including Canada focusing on coordination for
animal and human influenza outbreaks. Ultimately, continued binational
integration efforts continue through the HHS-led Border Health
Commission, which provides international leadership to improve health
and quality of life along the SWB.
future directions
We are working diligently to meet the requirements enumerated in
the fiscal year 2020 Homeland Security (DHS) Appropriations Act and the
Joint Explanatory Statement. In addition, we continue to address the
integration of health care along the SWB to include, to the degree
possible, integrated health record systems, disease surveillance,
access to and continuity of quality health care for those in our
Department's care and custody. We are also working to update the Land
Mass Migration Plan for surges and mass migration along the SWB that
will include a Medical Annex. The effort includes developing solutions
that prevent the back-up of migrants in custody occurring in Border
Patrol Stations. Like, and in conjunction with the update to the
Maritime Mass Migration Plan and Medical Annex, this will address
interagency, State, local, and private-sector roles, responsibilities,
and authorities, thresholds for phased implementation of the responses,
and requirements identified for further resourcing.
At DHS, we remain committed to ensuring that individuals in custody
receive appropriate care, including medical support, but these efforts
do not address the on-going challenges we face due to continued migrant
flows and changing demographics. Once again, we urge Congress to take a
comprehensive look at the immigration laws and the implications from
those court decisions that shaped immigration laws. Real change
requires real reform.
Thank you for the opportunity to testify before you today. I look
forward to your questions.
Miss Rice. I thank all the witnesses for their testimony. I
will remind each Member that he or she will have 5 minutes to
question the panel. I will now recognize myself for questions.
Chief Hastings, early last month, ProPublica released video
footage of Carlos Hernandez Vasquez, who was being held in
Border Patrol custody in May 2019. The video shows in
heartbreaking detail the last hours of Carlos' life. He was 16
years old at the time. He died in his cell just hours after a
nurse practitioner apparently recommended immediate medical
care. In fact, his body was first discovered by his cellmate
who was another child who was being held in detention.
Understanding that this specific case is still under
investigation, what can you tell us about the lesson CBP has
learned from this particular case?
Mr. Hastings. So ma'am, I would start by saying, dignity
and care of those are of the utmost importance. I am a father.
I have a granddaughter as well. I watched the video. I saw the
same video from the media report, and the video itself was
troubling. As you know, the case is still under OIG
investigation. I can't speak to what their findings are. One
thing I can add is that I know that all of the video has been
turned over, all of the items that we had. The video of all the
cells has been turned over to OIG, and they have all the video,
not just a piece, as I understand, that was pulled from the
sheriff's department.
Miss Rice. So are you insinuating that there is more--I am
not sure what you are insinuating.
Mr. Hastings. So as I said, all of the video that we had
throughout the station that day has been turned over to OIG.
Miss Rice. What did it show?
Mr. Hastings. I haven't seen it, ma'am. I just know that we
have turned it over and provided to OIG, who is the independent
investigator.
Miss Rice. I was just curious about what you were
insinuating by saying, we just saw a little snippet but that--
--
Mr. Hastings. I am just insinuating we have turned over all
the evidence and all the video.
Miss Rice. OK. So broadly speaking what do you think could
have been done differently, without talking about what was
done, your review of the case, what do you think could have
been done differently?
It has been indicated that welfare checks were conducted on
this young boy, young teen, but the video shows an increasingly
sick Carlos in pain, vomiting up blood, writhing around in pain
until he falls unconscious to the floor of his cell, and this
happened over a course of hours.
So I am wondering, is there a finding by just your internal
review that maybe it wasn't understood, the level of medical
attention that he needed when he was in the cell at that time?
Mr. Hastings. So again, it is on-going, and certainly any
lessons learned from any of the investigations, this
investigation or any others, we will look at to make changes. I
can tell you that we did put out guidance to the field that any
of those--and I believe this was July--a memorandum from then-
Commissioner Saunders went out--any subject in our custody were
receiving welfare checks every 15 minutes and being documented
in our system of record.
Miss Rice. You mean person, not subject, in your custody.
Mr. Hastings. Person, yes, ma'am.
Miss Rice. Because that is what they are, they are people,
not subjects.
Mr. Hastings. People, ma'am.
Miss Rice. Can you tell us what policies are in place to
ensure that recommendations that you received from medical
professionals are actually followed and what measures exist to
protect health care professionals who refuse to clear patients
for detention?
I mean, I am assuming that a CBP officer has to stay with
any child or human in detention if they go to a health
facility. Is that correct?
Mr. Hastings. That is correct.
Miss Rice. Are you aware of pressure that CBP officers are
putting on medical professionals to release patients so that
they can get back to their job at the border or whatever
facility to which they are assigned?
Mr. Hastings. No, ma'am, I am not. In fact, in reviewing
some of the IG investigation material I saw the contrary where
one of our agents actually asked for additional care and stood
up for one of the children that was sick until the fever was
down. So we have seen the opposite of that.
Miss Rice. Well, that is a good story to hear, but there
have also been indications that health professionals feel
intimidated and pressured by CBP personnel to release patients
to detention even when it is not medically indicated. To me, it
seems like a doctor should be the ones making these decisions,
not CBP officers.
What policies are in place to ensure that recommendations
of medical professionals are followed? I mean, are there
policies? I mean----
Mr. Hastings. So yes, we have multiple policies, and we
work closely with both CWMD as well as our own office of
support. We have medical staff at our--that we have hired to
oversee the contract and to make sure that we are providing the
best care we can in the family practitioner model.
Miss Rice. Dr. Eastman, it is good to see you again. As the
senior medical officer in the Department of Homeland Security,
when you make recommendations for the medical care of
individuals in CBP's custody, are they followed by CBP?
Dr. Eastman. Nice to see you as well, ma'am, and yes, we
work collaboratively with CBP to advise and help implement the
recommendations that we offer. In fact, we have our employees,
CWMD employees, the senior medical adviser at CBP, and this
team works collaboratively to implement the recommendations
that are made with a hardy respect to the fact that there are
operational considerations as well.
Miss Rice. If you look at some of the cases involved with
the children that I mentioned, every single one of them was
very, very sick and should have been hospitalized and never
released back into CBP custody.
So there has to be, I would hope, some effort to review
where these mistakes were made, that these children who were
very, very sick, one of whom had a temperature of 105.7, when
they were initially examined, I mean, I just don't understand
how that could even be possible.
I mean, are CBP officers trained to--I know they are not
medical professionals, but it doesn't take--you don't have to
be a doctor to see that a child has a 105.7 temperature. So
what----
Dr. Eastman. Ma'am, we do the absolute best we can to
provide the best care possible to the children in our custody,
but there is not a mechanism for us, as the Department of
Homeland Security, to review the care that is provided outside
our system in community hospitals all along the border. I
think----
Miss Rice. Well, I am talking about that initial--I mean,
it was a nurse practitioner, I believe, who examined Carlos and
gave him Tamiflu because that is what he was diagnosed with.
But have you recommended flu vaccines for detained migrants?
Dr. Eastman. Ma'am, our approach to the flu vaccine is a
comprehensive one, that encompasses all of the settings where
care is delivered along the Southwest Border. In fact----
Miss Rice. So is everyone given, is every detained migrant
given a flu shot?
Dr. Eastman. The Department of Homeland Security's
vaccination strategy has resulted in more than 60,000
vaccinations being given, predominantly in the ISL service
core. Our goal is to give the right vaccine to the right person
at the right time.
Miss Rice. Have you spoken with the Acting Secretary about
ways to ensure that CBP follows your medical recommendations?
Dr. Eastman. Ma'am, like I said, the direction from
leadership, from the Secretary to all the Acting Secretaries I
have worked has been the same, to do the right thing for the
people in our custody and for all of us to work together to do
just that.
Miss Rice. I understand. I am just asking you--and you can
just say yes or no--have you specifically spoken with the
Acting Secretary about ways to ensure that CBP follows your
medical recommendations?
Dr. Eastman. Yes, ma'am. Prior to his current role as the
Acting Secretary, we spoke along the border.
Miss Rice. Do you continue those conversations?
Dr. Eastman. Yes, ma'am. Absolutely.
Miss Rice. Thank you. I now recognize the Ranking Member,
Mr. Higgins.
Mr. Higgins. Thank you, Madam Chair.
Chief Hastings, the President requested emergency
supplemental assistance to address the crisis at the border on
May 1, 2019. It took 2 months for that money to be approved by
Congress and to get that money to the field to provide relief.
Meanwhile, the Department of Health and Human Services ran
out of money for unaccompanied minor bed space. Please explain
to the committee, and the Americans watching this hearing, the
immediate impact that supplemental funding had on Customs and
Border Protection operations at the border and CBP's ability to
move unaccompanied minors out of CBP facilities and into ones
more suitable for children, including professional medical
care.
Mr. Hastings. Thank you for the question, sir. So as
everyone is fully aware, we dealt with 321,000 total children
last fiscal year. Those were both UACs and in families. We have
never seen those kind of numbers before. That quickly
overwhelmed the entire system. Specifically in May and June
time frame, 144,000 apprehensions in May, or arrests, and the
inadmissibles as well. The system got backed up.
We were still processing in about, on average, 25 hours per
average per UAC, but the UAC couldn't move. HHS was out of
funding, they were out of money, and they were telling us they
couldn't move those in our custody. By law, there is nothing
more we can do with the UAC either, other than turn them over
to HHS.
Mr. Higgins. Thank you for that clarification. In the
interest of perspective for the American citizens viewing this
hearing and for my colleagues on the committee, let me just say
that there has been an undercurrent or insinuation that Customs
and Border Protection has in some way been neglectful of caring
for children.
I believe we all accept that the medical facilities of the
United States of America, the hospitals of America, will
provide some of the finest care in the world, arguably the
finest care in the world. We will investigate any death of any
child that is in the custody of Customs and Border Protection,
and those deaths should be investigated. Every loss of a child
is tragic, and we should take a deep breath and look at that.
But for the sense of perspective, let me say that in 2017
alone, 28,308 juveniles died in professional medical facilities
in the United States of America. Many of these children arrive
at the border, they are very sick. They are struggling, no
telling what they have been through. CBP does their best to
take care of them. But tragically sometimes children die,
including 28,308 children in American hospitals in 2017 alone.
Those are Government numbers from the CDC.
In our juvenile detention facilities, it is not uncommon
historical data from the Government to show an average of about
10 deaths in a 6-year period. These are juveniles in juvenile
detention facilities in America, much better designed and
equipped to care for the children in their custody. The men and
women that wear badges care about the children that come under
our care.
I lost my first-born daughter in a hospital. I lost many
more on the street, children in my arms, a young teen hit in
the head by an axe handle over an unpaid drug debt. I sat there
in that dark street and held that young man's head, whispering
prayer into his ear as the life light left his life. Infant
child, unresponsive, hysterical parents, I did my best to
perform infant CPR to resuscitate that child. She didn't make
it.
Dr. Eastman, in my remaining 25 seconds, sir, please
respond to the spirit with which Customs and Border Protection
addresses any sick child that comes into our custody.
Dr. Eastman. In my experiences, sir, CBP officers, Border
Patrol agents, they are law enforcement officers, most of them
are parents as well, and they act exactly as you describe, to
do the best they can under the circumstances they are dealt.
Mr. Higgins. Thank you, gentlemen, for appearing today.
This is a painful and necessary hearing, and I thank Madam
Chair and the Chairman of the whole committee, for allowing us
to discuss how we can improve the care for the children that
come through our border.
Let us not forget that we must operate based upon the
cornerstones that have defined America as we attempt to care
for all of our children.
So I thank you again, Madam Chair, for holding this
hearing, and I yield.
Miss Rice. Apropos of that, Mr. Hastings, would you--oh, I
am sorry. Apropos of what my friend, Mr. Higgins, was asking
you, would you agree that taking $3.5 billion from the military
counter-drug program would be problematic? Because there is
reporting today indicating that the President is planning to
divert $7.2 billion in Pentagon funding to build his wall.
Would you find that to be problematic in terms of addressing
the issues that you testified about?
Mr. Hastings. So ma'am, I would also add, though, on the
other hand, we had a very large influx of families and
children. We also had an influx of single adults. We saw those
numbers go up. I would also add that we had 147,000 got-aways
that we know of last year.
So we had not only asylum seekers turning themselves in,
but people trying to elude as well. We need--this is a whole-
of-Government approach to many things that we need to protect
and safeguard our borders.
Miss Rice. Do you think taking $3.5 billion from a military
counter-drug program would be a problem to address the issues
that you are--yes or no?
Mr. Hastings. We need a border wall, I can tell you that.
Miss Rice. I didn't ask you that. Can you answer the
question I asked you?
Mr. Hastings. Can you ask the question again?
Miss Rice. Sure. Do you think it is problematic that the
President wants to take $3.5 billion from military counter-drug
program?
Mr. Hastings. I think we--again, I would say----
Miss Rice. Is there a reason why you can't just say yes or
no.
Mr. Hastings. No, I don't.
Miss Rice. So you don't think--that is not problematic?
Mr. Hastings. For our needs, there are needs that we have
on the border as well to secure our border, and wall and
construction is one of those.
Miss Rice. I now recognize Chairman Thompson for 5 minutes.
Mr. Thompson. Thank you very much, Madam Chair. The title
of our subcommittee hearing today is ``Assessing the Adequacy
of DHS's Efforts to Prevent Child Deaths in Custody.'' My
comments talked about one death in custody is too much.
I understand that since the deaths have occurred, there is
an interim medical directive that talks about, that we will no
longer do medical assessments for children under 18. Are you
familiar with that, Mr. Hastings?
Mr. Hastings. Sir, our new policy that just went into
effect says we are doing health interviews for all of those
less than 18, and we are doing health assessments, which is
basically like a physical, for all of those 12 and younger, or
anyone who says that they have a health condition or a medical
issue.
Mr. Thompson. So, Dr. Eastman, are you familiar with that
policy?
Dr. Eastman. Yes, sir. Yes, sir, I am.
Mr. Thompson. Explain it a little bit for the committee.
Dr. Eastman. Yes, sir. CBP uses a phased approach to meet
the medical needs of the population in our custody.
The first phase involves recognition of illness and the
encouragement of migrants to report to us that they have an
issue.
The second phase is a health interview that has been
standardized across Customs and Border Protection, using a
questionnaire, able to be administered by a law enforcement
officer but developed in concert with experts at the CDC and
across the Government, with a two-fold purpose--to identify an
emergent medical condition, but also to identify the potential
of an infectious disease that might harm the migrant or
threaten the United States.
The third phase of that approach is a medical assessment
from a qualified provider. That medical assessment in the final
medical directive is given to anyone with a positive finding on
the health interview, or to any child under 12, or to anyone
who requests it.
Mr. Thompson. So----
Dr. Eastman. I would also add, sir, just 1 second, the last
phase of that care plan is for any true world emergencies, you
know, someone that would need cardiac care, we are obviously
utilizing the local health care system where the migrants area.
Mr. Thompson. So why would you determine 12 as the cut-off
for an assessment?
Dr. Eastman. Yes. So the way the directive was derived was
a collaborative approach from all of us involved from DHS and
CBP and the other experts, and the way the directive was
approached, was felt that a teenager would be able to seek and
request medical care when necessary.
Mr. Thompson. So what outside groups did you talk to when
you did this assessment?
Dr. Eastman. Yes, sir. We have incorporated advice from the
Assistant Secretary for Health, as I mentioned, several members
of his staff who are seasoned pediatricians. In addition, we
worked with a number of Public Health Service officers along
the border who help give us--who are pediatricians themselves,
with vast experience in everything from disaster response to
responding to ebola.
In addition, we hired a senior medical adviser for
pediatrics, an outside pediatrician with vast disaster
experience to come assist us. We also--and we continue to
listen to the groups that are involved in the care, including
the American Academy of Pediatrics, the family practitioners,
and other organizations who have given us advice on this topic.
We continue to utilize that advice to form our policies and
procedures.
Mr. Thompson. Well, I am happy that you mentioned the
American Academy of Pediatrics. Madam Chair, I have a letter
from the American Academy of Pediatrics that says there is no
medical justification to only assess children younger than 12.
So I want you to seriously consider the group you talked
about, because they are the one dealing with children, and they
are saying 12 is not a magic number. Some of us are concerned
that between 18 and 12 is a vast shortage of opportunity for us
to help children that we are talking about here today.
So I just want to put that in the record, Madam Chair.
Miss Rice. So received.
[The information follows:]
Statement of the American Academy of Pediatrics
January 14, 2020
Chairwoman Rice and Ranking Member Higgins, thank you for the
opportunity to provide written testimony about the adequacy of the
Department of Homeland Security (DHS)'s efforts to prevent child deaths
in custody. The American Academy of Pediatrics (AAP) is a non-profit
professional membership organization of over 67,000 primary care
pediatricians and medical and surgical pediatric subspecialists
dedicated to health and well-being of all infants, children,
adolescents, and young adults. The mission of the AAP is to protect the
health and well-being of all children, no matter where they or their
parents were born. As pediatricians, our primary responsibility is to
support families in order to optimize child health. We strive to help
all children to grow, develop, and reach their full potential to
contribute to our collective America.
As we testified to before your subcommittee in March 2019, AAP
continues to believe that current conditions and protocols in Customs
and Border Protection (CBP) custody are inconsistent with evidence-
based recommendations for the appropriate care of children. Children
simply should not be subjected to these facilities. For over a year, we
have been calling on DHS to implement specific meaningful steps to
ensure that all children in CBP custody receive appropriate medical and
mental health screening and necessary follow-up care by trained
providers. We have also sought to provide expert advice to DHS and CBP
about how to best care for and treat children in custody and continue
to offer this expertise to the agencies.
The deaths of so many children in CBP custody, the horrifying video
of Carlos Gregorio Hernandez Vasquez's last hours in a CBP jail cell,
and the observations of the AAP leadership, DHS Office of Inspector
General, and others should be a call to action for DHS. We once again
urge CBP and DHS to increase medical staffing with individuals who have
pediatric training at its facilities so they can monitor, screen and,
where possible, treat children who are sick. We urge CBP and DHS to
require that all children under age 18 are medically screened by a
medical professional with pediatric training, to have plans for
appropriate space to isolate ill individuals, and to prioritize the
transfer of unaccompanied children to the Office of Refugee
Resettlement (ORR) as quickly as possible.We are aware that the Centers
for Disease Control and Prevention (CDC) issued a report to DHS based
on findings by 3 CDC teams who visited DHS Border Patrol facilities in
December 2018 and January 2019. CDC's recommendations are reasonable,
routed in public health, and, if implemented, would greatly reduce the
risk of infectious disease transmission and ensure more appropriate
screening and treatment for children while in CBP custody. We urge the
subcommittee to conduct oversight on whether any of CDC's
recommendations have been implemented and continue to conduct robust
oversight on how the hundreds of millions of dollars that Congress has
already appropriated to DHS/CBP specifically for medical and
humanitarian care through the regular and supplemental appropriations
process have been spent.
unique needs of children
As pediatricians, we know that children are not little adults.
Children's vital signs (breathing rate, heart rate, blood pressure)
have different normal parameters than adults, and these parameters vary
by age. When children begin to get sick, they present with subtle
findings, and they tend to get sick more quickly. For example, children
can become dehydrated more quickly than adults. They require greater
amounts of fluid per pound of body weight than adults, and high fevers
and fast breathing can cause children to lose fluid quickly. Children
also need encouragement to drink when they are ill, and this
encouragement is exceedingly difficult to provide to frightened
children.
The flu can be particularly serious for children and can escalate
quickly. Signs differentiating a child with mild illness from a child
with severe illness are quite subtle. A child can be happily playing,
even running around, while her body systems begin to shut down. When a
child is having difficulty breathing, she may breathe more quickly or
her ribs may pull in with each breath; these signs would often not be
easily visible, especially not to an untrained eye. Additionally,
children are more prone to muscle fatigue, including the breathing
muscles, and are thus at greater risk for respiratory failure.\1\ Even
the dosing of common medications is different in children than it is in
adults; rather than standard dosing, children are dosed based on their
weight.\2\
---------------------------------------------------------------------------
\1\ Woollard M, Jewkes F. 5 Assessment and identification of
paediatric primary survey positive patients. Emergency Medicine
Journal. 2004;21:511-517.
\2\ Palchuk MB, Seger DL, Recklet EG, Hanson C, Alexeyev A, Li Q.
Weight-based pediatric prescribing in ambulatory setting. AMIA Annu
Symp Proc. 2006;2006:1055.
---------------------------------------------------------------------------
Sepsis, for example, must be treated early in children. According
to the Society of Critical Care Medicine (SCCM), sepsis is a
complicated disease causing the body to be compromised by serious
systemic infection leading to multiple organ failure.\3\ The importance
of recognizing and treating sepsis early in children cannot be
underestimated; each hour of delay in treatment dramatically increases
mortality. Because sepsis can be so serious and so difficult to
recognize in children, the SCCM has a separate set of guidelines for
recognizing and treating sepsis in children that are different than for
adults.\4\ For these reasons, it is essential that the individuals who
interact with children apprehended at the border are trained to
recognize signs and symptoms of distress and know when to urgently
refer children to additional care.
---------------------------------------------------------------------------
\3\ Weiss SL. Five Important Things to Know about Pediatric Sepsis.
Society of Critical Care Medicine. https://www.sccm.org/Communications/
Critical-Connections/Archives/2018/Five-Important-Things-to-Know-About-
Pediatric-Seps. Accessed March 4, 2019.
\4\ Dellinger RP, Levy MM, Rhodes A, et al: Surviving Sepsis
Campaign: International guidelines for management of severe sepsis and
septic shock: 2012. Crit Care Med. 2013; 41:580-637.
---------------------------------------------------------------------------
recent cbp actions
Unfortunately, CBP's recently released Medical Directive is wholly
inadequate to ensure the proper care of children in custody and
represents a step in the wrong direction as compared to the Interim
Medical Directive dated January 28, 2019. For example, the new
Directive no longer requires medical assessments of all children under
18. Although the directive indicates that tender-age children (ages 12
and under) will receive a medical assessment, that is heavily caveated.
As medical providers for children, there is no medical justification to
only assess children younger than 12. All children should be routinely
screened and treated, as necessary. Further, the directive no longer
defines a medical assessment as including taking vital signs severely
weakening what an actual medical assessment is and gives no definition
to the required qualifications of ``health care providers'' including
that anyone interacting with a child have any pediatric training.
We understand that CBP has hired 4 contracted pediatric advisors
for the entire Southwest Border to provide pediatric expertise and
consultation, support medical quality management efforts, advise
pediatric protocols and support training. However, it does not appear
that the contracted pediatricians will actually be providing care to
children in CBP custody. In order to ensure proper care of children in
CBP custody, there must be a robust pediatric medical presence at the
border.
aap recommendations
1. Because conditions at CBP processing centers are inconsistent
with AAP recommendations for appropriate care and treatment of
children, children should not be subjected to these
facilities.\5\ The processing of children and family units
should occur in a child-friendly manner, taking place outside
current CBP processing centers and conducted by child welfare
professionals, to provide conditions that emphasize the health
and well-being of children and families at this critical stage
of immigration proceedings.\6\
---------------------------------------------------------------------------
\5\ Linton JM, Griffin M, Shapiro AJ. Detention of Immigrant
Children. Pediatrics. 2017;139(5).
\6\ Ibid.
---------------------------------------------------------------------------
2. All children, throughout the immigration process, should have
access to comprehensive, trauma-informed care, including
preventative care, chronic condition management, dental care,
and mental health treatment, when indicated. Humanitarian
standards should also be implemented to ensure that immigrants
receive proper nutrition, hygiene, and sanitation while in CBP
custody. Pediatricians stand with the immigrant families we
care for and will continue to advocate that their needs are met
and prioritized.
3. CBP agents, including those who are not trained as EMTs or
paramedics and those who work in remote areas along the border,
should be trained to know how to identify the signs of a child
who is in medical distress and needs immediate medical
attention. Ideally, such training would be both on-line and in-
person. While it may not be possible to provide pediatric
medical training to all CBP agents, we can work to ensure that
they are better prepared to identify a sick child and to get
that child into appropriate care. We must also ensure that CBP
provides its agents with necessary basic supplies such as oral
hydration, food, first-aid kits, and other supplies that could
be life-saving should those agents encounter a sick child. The
AAP is pleased to support S. 412, the Remote, Emergency,
Medical, On-line Training, Telehealth, and EMT (REMOTE) Act,
which addresses many of these recommendations.
4. The Academy is urging CBP to ensure that all children under 18
years of age receive evidenced-based medical screening and care
from professionals trained in pediatric care. We must have
medical professionals who are trained in the care of children
screening and treating vulnerable children who are in the
custody of our Government.
5. Children who are identified as needing additional medical care
should be immediately referred for evaluation and treatment, at
a children's hospital if there is one available. Procedures
should be in place to ensure that when children need treatment,
they are quickly able to receive appropriate care and have
access to professionals trained in the care of critically-ill
children during transport.
6. Screening and treatment should occur in the child or parent's
preferred language so as to ensure the family is able to
understand what is happening and accurately answer questions.
This means that trained medical interpreters should be used in
all clinical encounters with children and their families.
7. Sick children, children who have been hospitalized, or children
with special health care needs should not be returned to a CBP
processing facility. When a child is diagnosed with an illness
in a pediatrician's office or is discharged from an emergency
room or a hospital, he or she is sent home to recover with
plenty of rest and a parent to care for them. Parents of
children being detained in CBP processing centers do not have
that luxury; rather, the conditions in the centers themselves
exacerbate children's suffering, and without medical
professionals who understand the signs and symptoms to look for
to assess a child's condition, these children are at further
risk. A sick child should recover in the comfort of a home or
child-friendly setting under the care of a parent or caregiver,
not on a cold, concrete floor in Federal custody.
8. Independent oversight of locations in which children are
temporarily housed, detained, or sheltered is critical.
Licensure of those locations is important to ensure appropriate
care and oversight. As these locations are selected, we
encourage DHS and HHS to consider their remoteness as that can
impact proximity and access to trained pediatric providers.
9. Medications should not be confiscated from a child unless
approved by a pediatrician at a CBP facility. Children with
chronic or acute medical conditions rely on life-saving or
life-sustaining medications. Children whose medications have
been confiscated by CBP may go days or weeks without needed
medications as these medicines are not always replaced by CBP
in a timely manner. Pediatricians throughout the country have
reported children needing to be hospitalized, sometimes in the
intensive care unit, as a result of the conditions in CBP
facilities including the confiscation without replacement of
their medications.
10. The AAP has called for a thorough, independent investigation of
the Government's detention practices, including the appointment
of an independent team comprised of pediatricians, pediatric
mental health providers, child welfare experts, and others to
conduct unannounced visits to Federal facilities including CBP
processing centers, ICE family detention centers, and ORR
shelters to assess their conditions for children, capacity to
respond to medical emergencies involving a child, and to ensure
that immigrant children receive optimal medical and mental
health care. These experts need unfettered access to sites
where children are held in Federal custody to ensure that they
receive suitable care while there.
Thank you for the opportunity to provide written testimony. We look
forward to working with you to ensure that all children who reach our
border receive appropriate medical and mental health screening and
treatment.
Mr. Thompson. All right.
So Mr. Hastings, why did it take the Department as long as
it did to revise this directive? Are you familiar with that?
Mr. Hastings. So we did put out an interim directive
immediately, in December. Then we worked with these various
components as was mentioned earlier, internally and externally,
our stakeholders, to make sure that we got this right. But the
interim policy was in effect since December 2018.
Additionally we didn't wait to take actions. We were taking
many other actions, including increasing our contract personnel
even before that.
Mr. Thompson. So are you familiar with the clause ``subject
to availability of resources and operational requirements'' in
that directive?
Mr. Hastings. Resources and obligations?
Mr. Thompson. Resources and operational requirements.
Mr. Hastings. Am I--I am not sure what you are referring
to, which part, sir.
Mr. Thompson. The same directive you talked about that has
been developed.
Mr. Hastings. Well, for one thing, sir, we need funding--
and it does mention funding in there--to continue our
assistance with resources, is funding basically to continue the
assistance with our contract medical providers.
Mr. Thompson. So who makes decisions as to whether
resources are available?
Mr. Hastings. It is based on budgetary need. The other
thing----
Mr. Thompson. So who makes that decision?
Mr. Hastings. So if we continue to receive funding to
provide the current services we are, contract services will
continue to do that.
Mr. Thompson. Well, do you make the decision or who?
Mr. Hastings. Sir, we have to be funded to continue for
one----
Mr. Thompson. I am not talking about--I am not talking
about--I am saying, who makes the decision, what individual, in
the implementation of this directive?
Mr. Hastings. So, as I said, we have implemented the
directive. When we would have had difficulty, what you are
referring to in staying with the directive, would have been
very difficult when we were backed up and had 7,500 children--
--
Mr. Thompson. So when you said ``we,'' is that you?
Mr. Hastings. That is the Border Patrol.
Mr. Thompson. So who at the Border Patrol makes that
decision?
Mr. Hastings. We would make it operationally and provide a
heads-up to Congressional.
Mr. Thompson. So there is no individual by name that you
can give this committee?
Mr. Hastings. Sir, we constantly brief what we have going
on on the border, as far as the amount of numbers we are seeing
and the resources that we are using down there.
We consistently brief up what we are seeing on the border
and the situation, and throughout the crisis, we continue to
brief those numbers. We were overwhelmed is my point.
Mr. Thompson. Well, but that is--I am talking about the
directive. I am not talking about the conditions. You put a
directive in place.
Mr. Hastings. We have.
Mr. Thompson. You said ``subject to the availability of
resources and operational requirements.'' I am asking you, who
makes that determination, what individual?
Mr. Hastings. So we will continue to do that. I would
imagine that would go to the highest levels. It would probably
go to the chief or the commissioner to stop something as
important to this, and we would certainly notify their entities
if we were forced into a situation, overwhelmed or not budgeted
for this. We would certainly notify----
Mr. Thompson. I am having real difficulty with you not
giving us a name. I mean, I am just--it is not a gotcha
question. You got a requirement that you pushed out. Someone
has to be responsible for making decisions on that requirement.
I am just asking, for my sake and I hope for other Members
of the committee, who that individual is.
Mr. Hastings. It would be the chief in consultation with
the commissioner. We would advise, like I said----
Mr. Thompson. Is that you?
Mr. Hastings. No. I am not the chief of Border Patrol. I am
the chief of operations. I oversee all the operations in field.
Mr. Thompson. So the chief of Border Patrol would interpret
the policy we are talking about now, in terms of resources and
other things?
Mr. Hastings. When we did not have the resources to fulfill
that obligation, that is what you are referring to, I believe.
Mr. Thompson. No. I am talking about the new policy that
was put in place in response to the death of the children, and
it said that it is subject to the availability of resources and
operational requirements. I am just trying to get a sense of
who is in charge of making those determinations?
Mr. Hastings. So we--again, it would be--we have to be
properly resourced to be able to carry this out with our
contract employees. We have to be properly--we have to have the
proper funding to do that.
Operationally, it would be the chief and the commissioner
that would pass this down in close work with the field
commanders and the chiefs in the field.
Mr. Thompson. Madam Chair, I think my problem is, we have
had a problem, and we have had some proposed solutions, but we
are not--I am not comfortable with who is responsible for
carrying it out, to the point that we might end up with another
situation because the directive is unclear and subject to
anyone's interpretation. I am just trying to make sure these
problems don't happen again.
Mr. Higgins. Will the gentleman yield for 10 seconds?
Mr. Thompson. Be happy to.
Mr. Higgins. Thank you, Mr. Chairman, Madam Chair. I
believe that the witness is attempting to answer the question
to the best of his ability. You asked him for one name, and the
answer was that there are many names.
Chain of command is a multitude of men and women that make
these decisions on an operational basis based upon what they
are dealing with in the field at that time, and they report up
chain and down chain. So the answer is not one name.
Ultimately, the gentleman referred to at the highest level
is responsible, but the implementation of a new policy would be
based upon the work done throughout the chain of command. So it
is many people, it seems to me.
Mr. Thompson. Well, you didn't help either with the
response. So I am still, for clarity's sake, if we have come up
with a new policy, Madam Chair--and we might just have to
follow up with some subsequent language requests----
But I think it is not unreasonable, if a policy is put out
on an issue this critical, for us not to have those individuals
who are tasked with the responsibility of making sure they are
carried out.
So I yield back.
Miss Rice. Thank you. The gentleman from Pennsylvania, Mr.
Joyce, is now recognized.
Mr. Joyce. Thank you, Mr. Chairman, Madam Chair, Mr.
Ranking Member.
Dr. Eastman, in the fiscal year 2019, more than 200 large
groups of 100 people or more, often of various ages, arrived
along our Southwest Border. Many of these large groups arrived
during the height of the flu season, and during months of
intense high heat.
Can you give an estimate of how many of these migrants
likely arrived at the border with a preexisting illness or
infectious disease in fiscal year 2019?
Dr. Eastman. On an individual basis, most of the migrants
we saw overwhelmingly were well, but there were notable cases
that were not. I will take that back for the record to try to
get you a more exact number, because I think, you know, we have
got the data. I don't have a specific number.
But mostly, overwhelmingly, they were well, but your point
is exactly accurate, that folks are coming to us after a long
journey, many of them with the flu or another infectious
disease that needed to be addressed.
Mr. Joyce. For those who were traveling hundreds of miles
to our border, what was the likelihood that they had access to
medical treatment along their journey?
Dr. Eastman. Sir, I am not the expert on the care that
occurs from--prior to them reaching, you know, our Southern
Border. We have worked collaboratively with the government of
Mexico to try to, you know, help them do everything they can to
improve conditions on the Mexican side of the border.
I know the Department has a number of efforts in Central
and South America to facilitate other parts of this, but I am
certainly not the expert on what happens prior to the migrants
reaching our border.
Mr. Joyce. Thank you. You mentioned that potential
infectious diseases have been with these migrants as they
presented to our border. Can you tell us more about that,
please?
Dr. Eastman. Yes, sir. Predominantly, what we have seen is
seasonal influenza. We have also seen sporadic cases of
tuberculosis, chickenpox, you know, varicella-zoster virus. We
have seen some mumps. Knock on wood--I am superstitious and
hesitant to say this--we have not seen a case of the measles.
But those are predominantly the diseases that we have seen.
Mr. Joyce. In contrast to children who have presented with
grave illnesses, can you tell us how many children that you
estimate have been saved by the medical attention provided
under the United States Government's custody?
Dr. Eastman. Sir, that number is a difficult one to pin
down directly, but from the beginnings of my work along the
border, we know that about 10 percent of the migrants that come
across will end up going into the medical assessment process.
Again, those are rough very early numbers in the crisis.
How many were saved directly, I can't pin down. It is hard
to predict. But there are certainly lives that have been saved
by the response to this crisis.
Mr. Joyce. Dr. Eastman, continuing, during this crisis, the
CBP received medical surge assistance from interagency
partners, like the United States Coast Guard medical teams, and
personnel from the United States Public Health Service. How
important is having additional medical staff on-site at CBP
facilities?
Dr. Eastman. Sir, it is important to remember that, you
know, CBP is a law enforcement organization. We think that
health care is best provided in health care settings. However,
by virtue of the unprecedented crisis we faced, we had to mount
an unprecedented solution.
That care, you know, assessment and care that was initially
provided by our first responders, the Coast Guard, by our
intermediate responders, the Public Health Service, and then
now subsequently that is placed onto the backs of CBP's
contracted medical providers, that care is vital. It is vital
because we have got an unprecedented problem in the system, and
that is a very unconventional solution. I know of no other law
enforcement agency that I have ever interacted with or heard of
that has such a developed health care infrastructure inside it.
Mr. Joyce. So, in face of this unprecedented crisis, you
have been able to provide vital health care. Is that the
message that I am hearing from you, sir?
Dr. Eastman. Well, I wouldn't say I, I would say we. This
has been a collaborative interagency approach. At the heat of
the crisis, I spoke to Admiral Jawa and the chief medical
officers of the Coast Guard, who have changed hats recently,
but I spoke to them daily.
We, the Department, received help from them and many other
entities to provide what is clearly an unconventional solution
to this unprecedented problem.
Miss Rice. We thank you for doing that. Thank you both for
coming here today, for testifying in front of us.
I yield the remainder of my time.
The Chairman. Thank you.
The gentlewoman from New Mexico, Ms. Torres Small, is now
recognized for 5 minutes.
Ms. Torres Small. Thank you, Madam Chair. Thank you, Mr.
Ranking Member, and thank you, Chief Hastings and Dr. Eastman,
for being here today.
In December 2018, Jakelin Caal Maquin and Felipe Gomez
Alonzo died while in CBP custody after being detained in the
district that I represent. Subsequently, the DHS Office of
Inspector General opened an investigation into their deaths.
Three months later, in this committee hearing room, former
Secretary Nielsen testified that she directed the CBP's Office
of Professional Responsibility and the inspector general to
work as quickly as possible to complete these investigations.
Then in May 2019, my colleagues and I, again, urged the
Department and the inspector general to complete the
investigations in a timely manner. The OIG responded to our
request saying it was working to complete the investigations as
expeditiously as possible. But it was only last month, nearly a
year later after these tragic deaths that the investigations
were completed and provided to Congress. Even more concerning,
the OIG limited its investigation scope to only determine
whether there was malfeasance by personnel and did not consider
whether CBP's policies and procedures are adequate to prevent
migrant child deaths.
As I have said from the beginning, the reason for these
investigations is not to punish people; it is to keep this from
happening again. It is to make sure that we have the protocols
in place in case we are faced with this challenge again.
It is the committee's understanding that the investigations
did not even interview medical professionals outside of the
offices of the medical examiner and the Department. This is
unacceptable, especially given the significant number of family
units and unaccompanied children that traveled to the Southwest
Border last year.
Now, Chief Hastings, I deeply appreciate the work that the
men and women of Border Patrol do every single day and have
done in the past year to mitigate the situation we saw at the
Southern Border, and I want to find out whether the policies
and procedures of the agency are setting our agents up for
success to keep migrant children safe.
So, Chief Hastings, has CBP received the full reports of
these investigations?
Mr. Hastings. Ma'am, I have not seen a full report. I have
seen an abbreviated report from our Office of Professional
Responsibility.
Ms. Torres Small. Thank you, Chief Hastings. That is deeply
concerning. The committee was told by the OIG that CBP has
received the reports. So that is something we will follow up
on.
Mr. Hastings. I have not personally. I have not.
Ms. Torres Small. From the information that you received,
have you identified specific lessons learned that CBP took from
the reports and have recommended protocol changes to enforce
them?
Mr. Hastings. So I think one of the lessons learned is we
needed a standardized health form across the board for all of
CBP. One of the things that we saw, there were multiple forms
being used in the field throughout this entire year. That is
now standardized.
Ms. Torres Small. And you have the updated form?
Mr. Hastings. Yes, ma'am.
Ms. Torres Small. Any other lessons?
Mr. Hastings. That is one of the bigger ones. You visited
the location where we lost Jakelin. You are well aware of the
remoteness and the amount of time it would take to get even our
own agent out of that area, so I think you are very well-versed
with the issues of remoteness and rugged terrain that we had
out there as well as transportation. We have also added a large
transportation contract, buses and many other things to help
get folks from the border.
Ms. Torres Small. Thank you. That is a great lesson
learned, and it is certainly something I saw, so I am pleased
that Border Patrol is addressing that. Do you have multiple
buses now under contract?
Mr. Hastings. We do, under contract and our own personal
that we have purchased, vans and buses, as I mentioned earlier.
Ms. Torres Small. What about pediatric equipment? One of
the lessons learned for me with Jakelin's passing is not having
the appropriate cuff to take her blood pressure. Is there
pediatric equipment across the board along the border that is
available, if necessary?
Mr. Hastings. So we dedicated a large portion of the
supplemental funding to our EMTs. We have over 1,500 EMTs in
the field, and we have since updated them with equipment and
made sure that they have everything to meet their daily needs.
Ms. Torres Small. That is also part of protocol, so it is
required. If there is a deficiency, an agent has the ability to
alert, to fill that deficiency?
Mr. Hastings. That is correct.
Ms. Torres Small. Thank you. I want to shift now to
preventing the spread of infectious diseases in CBP stations.
Chief Hastings, what are the protocols that CBP has in
place to protect both migrants and CBP personnel from the
spread of infectious diseases, such as the flu inside Border
Patrol stations, processing centers, and ports of entry?
Mr. Hastings. So, with our contract personnel that we have
in all 9 Southwest Borders, and about 40 locations, put those
personnel based upon the highest vulnerable populations,
highest flow that we were seeing, as well as the least amount
of medical assistance in the general area, that is how we
decided where to put them. They are fully trained, and are able
to care and provide any type of antiviral flu and do flu
testing. They are able to do that. They are able to do acute
care and other things that aren't referred to secondary care.
Ms. Torres Small. You have written protocols that support
that need? Just yes or no, because I am out of time.
Dr. Eastman. Yes, ma'am, absolutely we do.
Ms. Torres Small. If you can supply those to supplement the
record, I would appreciate it.
Dr. Eastman. We will work to get that to you, yes.
Ms. Torres Small. Thank you.
My time is expired. Thank you.
Miss Rice. Thank you. We now recognize the gentleman from
Mississippi, Mr. Guest.
Mr. Guest. Thank you, Ms. Chairman.
Chief Hastings, I want to speak to you on the overall
immigration crisis that we have and are currently experiencing
along our Southwest Border. I note on page 7 of your written
testimony, you referred to fundamental flaws in the immigration
system.
You go on to say: ``CBP has pleaded with Congress to
address the layers of existing law and judicial systems that
adversely impact our ability to effectively manage our
immigration system. There are three key gaps in our legal
framework that Congress has yet to address.'' And you list
there the Flores settlement, the TVPRA, and the asylum
assertion.
Could you just take a few moments to expand on each of
these factors that you have listed there in your report and how
it impacts your Department's ability to secure our border?
Mr. Hastings. So we need the ability--under Flores, we need
the ability to be able to hold in a setting that provides fair
and expeditious immigration proceedings. Flores is a major
issue for us, completing that under the current 20-day process
that is required.
When we released over 149,000 families, when we were
interviewing these individuals, they literally told us that we
were told bring a child and we will be released. That is what
is encouraging this large flow that we continue to see. We
believe that they should be housed in an FRC together with all
of the adequate things that have been provided, medical,
dental, pharmacy, education, all the many other things.
The double standard for noncontiguous UACs, being able to
return a UAC to Guatemala, Honduras, other countries like we
are currently with Mexico and Canada, that would assist with
the large number of UACs that we are seeing cross our borders
today, again, a vulnerable population.
Last, tightening the asylum bar, the low asylum bar for
credible fear, as we see the massive backlog of over 1 million
cases right now.
Mr. Guest. Would you agree, Chief, that if Congress were to
address these 3 issues that you have set forth in your report,
that it would help stem the flow of illegal immigration that we
have recently seen across our Southwest Border?
Mr. Hastings. Yes, we believe it absolutely would.
Mr. Guest. Chief, you were asked a question earlier about
moving, or the shifting of money that was designated for the
Department of Defense to our Southwest Border for the purpose
of border wall construction.
Do you feel like that the construction of the border wall
system has improved your agency's ability to protect our
homeland?
Mr. Hastings. Absolutely. So, again, a border wall system
is more than just a wall: It comes with technology, it comes
with roads, gives us situational awareness, gives us impedance
and denial and time to respond. I have seen it work personally
in the many areas I have been in the field. I have seen what it
does for us, and I strongly support it.
Mr. Guest. Thank you. Just last, Chief, is there any other
recommendations that you would make to this committee as to how
we can better help your Department, again, to secure our
homeland, and then those individuals that are within our
custody that we can do our best to make sure that they are
protected and receive the care that they need?
Mr. Hastings. I just would request if we are not coming to
an agreement on some of the recommendations we gave that we
continue to fund HHS, so we can move those UACs through the
cycle and get them into the proper environment for care.
I would also request assistance with ICE funding as well
for single adult bed space, because that is another demographic
that we see backing up in our facilities at times. ICE needs
proper funding for single adult bed space.
Mr. Guest. Chief Hastings, thank you for your service to
our Nation.
Madam Chairman, I yield back.
Miss Rice. Thank you.
I now recognize the gentlewoman from New York, Ms. Clarke.
Ms. Clarke. Thank you, Madam Chair, and I thank our
witnesses for testifying here before us today.
Chief Hastings, last year, you testified before the
Judiciary Committee, and my colleague, Congressman Lieu, asked
you whether a 3-year-old girl could pose a criminal or National
security threat, and you responded, ``I don't know.'' I think
attitude goes a long way in addressing the multitude of issues
that you have before you, but specifically, preventing child
deaths in custody. I believe that we shouldn't be surprised
when children don't receive medical attention they need,
particularly when we don't know whether a 3-year-old can pose a
criminal or National security threat.
Having said that, last fall, I introduced H.R. 3777. It is
the National Commission to Investigate the Treatment of Migrant
Families and Children Act, which would create an independent
commission to study issues like family separation, as well as
the death of children in CBP custody.
But short of passing my legislation, we have to rely on the
Inspector General to get to the bottom of these matters. In a
report recently released by DHS OIG, it states that a Border
Patrol supervisor had to pay out of their own pocket for an
over-the-counter medication for 8-year-old Felipe, because
Border Patrol's insurance did not cover it. In addition, the
CBP EMT was unable to take a blood pressure of Jakelin, age 7,
because they lacked a pediatric cuff.
What steps has CBP taken to ensure access to basic medical
necessities and equipment across the Southwest Border?
Mr. Hastings. Ma'am, thank you for the question. So we did,
indeed, see an issue or a problem with Border Patrol or CBP
OFO, being able to fund nonprescriptions, over-the-counter
prescriptions. We have since fixed that. We have a contract
through ICE to be able to purchase any needed over-the-counter
remedy that is prescribed. So we have that. Then additionally,
as I mentioned earlier, thank you for the supplemental funding
that we were able to provide much-needed equipment for our EMTs
out in the field. So those have been fixed.
Ms. Clarke. Wonderful. I appreciate that. But, you know, in
the decade prior to 2018, there was not one single child death
in custody. So I am a bit concerned that, you know, there just
seems to be a callousness taking place.
I am glad that we are focused on this. However, if we are
able to shift funding for a border wall, we should be able to
shift funding to save human lives, particularly the lives of
children. We need to understand what went wrong in 2018 and
2019.
If a CBP official failed to take reasonable steps to
prevent the death of a child, what kind of disciplinary
measures do you think would be appropriate?
Mr. Hastings. Ma'am, I haven't seen anything----
Ms. Clarke. I am just asking hypothetically.
Mr. Hastings. I would have to see all the--everything that
went into the report. I would have to see the specifics. But if
it was negligible, we would certainly take immediate action.
Ms. Clarke. That is good to know. Has any CBP official
faced accountability for the death of children in custody?
Mr. Hastings. No, ma'am. There has been no negative
findings of malfeasance.
Ms. Clarke. OK. Fine, no problem. How does CBP determine
what expenses qualify as consumables or medical care?
Mr. Hastings. How do we determine--I am sorry, I didn't
hear you.
Ms. Clarke. How does CBP determine what expenses qualify as
consumables or medical care?
Dr. Eastman. Ma'am, let me help Chief Hastings with that.
We use the MedPar system, which is actually administered
through ICE. It is the DHS system that pays for care for
migrants in our custody.
In addition to that----
Ms. Clarke. Could you hold on 1 second. Could you just
provide us examples of the types of projects or activities for
which consumables and medical care funds have been obligated or
expended since the supplemental was enacted?
Dr. Eastman. Absolutely, ma'am. Again, thank you for the
supplemental funding. In response to that, at our more than 40
locations that now have contracted medical support, they have a
standardized formulary of medications and equipment that is
used to care for the migrants in custody.
So that is a clear example of how money has been
appropriated from the supplemental to help further the care of
children in our custody.
Ms. Clarke. How is that replenished? How do the
subcontractors----
Dr. Eastman. There is a--the contractor--I am not an expert
in their supply chain management, ma'am, but they have a system
that replenishes those. Again, the supplemental pays for that.
Ms. Clarke. Very well.
Madam Chair, I yield back the balance of my time.
Miss Rice. I now recognize the gentleman from California,
Mr. Correa.
Mr. Correa. Thank you, Madam Chair. Gentlemen, thank you
for being here today.
I am a Member of both this committee as well as the House
Judiciary Committee, where we have had numerous oversight
hearings concerning the dangerous detention facilities'
inadequate standards of care for migrants, including young
children.
Like my colleagues here, I am troubled by the multiple
reports of overcrowded facilities. I have actually toured some
of those facilities. There is a general agreement that CBP,
your facilities are not meant to handle the influx of children
and families that we have seen over the last 2 years.
So my question is, what contingency plans does the
Department have in place to ensure the safety of those within
your custody?
Mr. Hastings. So, sir, there are a couple things I would
add. As I mentioned in my opening----
Mr. Correa. Yes, sir.
Mr. Hastings [continuing]. We have 6 soft-sided facilities
with complete wraparound, medical/food services, shower, pretty
much all amenities. Additionally, we have planned long-term to
put central processing centers up in our busiest areas,
primarily the Rio Grande Valley, the El Paso sector, and the
Yuma sector. Those are modular buildings that are being
completed now or will be completed and started in the spring
for Yuma, but they are actually being completed right now for
El Paso.
So, in other words, having those facilities and those
wraparound services is something that we are planning for now,
and we have a long-term solution.
Mr. Correa. Mr. Hastings, I know you are chief of
operations, but if I can pull back a little bit, when General
Kelly was Secretary of Homeland Security, here in this
committee, he testified--and I am going to paraphrase him--that
border security goes beyond our border. I am thinking to
myself, you don't wake up one morning and say, Oh, my gosh,
look at all those folks at our doorstep. I have to imagine you
coordinate with other agencies and Federal Government with
other governments and begin to see that flow of refugees, that
flow of migrants moving.
So, my thought is, how do you prepare, or are you preparing
for those ensuing waves of refugees that are coming not only
from south of the border, not only from Central America, but
other parts of the world? I don't see this as a one instant
phenomena but, rather, as the world areas of conflict continue
to escalate, as you have folks in harm's way, this is going to
continue to be a challenge, migration, refugees from around the
world. Are you doing anything to anticipate these kinds of
situations, near future, long-term?
Mr. Hastings. Yes. So we are embedded with multiple
different governments, work closely with the Northern Triangle
and have agents on the ground down there working with them now.
Also work very strongly with our Mexican law enforcement
partners as well on a day-to-day basis, the chiefs in the
field.
Mr. Correa. Let me ask you----
Dr. Eastman. Sir, may I just add something?
Mr. Correa. Yes. Go ahead, Mr. Eastman.
Dr. Eastman. In addition to what the Border Patrol does,
the National Biosurveillance Information Center, which is a
CWMD entity, you know, with the chief medical officer, works
continuously with our partners, not just Mexico, but our
partners south of the border and world-wide, to identify and
begin to recognize and counter, you know, health-based threats
to the United States. That is part of the package.
Mr. Correa. So a little while ago, my colleagues talked
about the flu vaccinations. Essentially, your response, I
believe--and you can confirm this or not--operational
challenges have prevented you from really vaccinating a lot of
those individuals that need it, yes/no?
Dr. Eastman. No, sir, that is definitely not my response.
Just to be clear----
Mr. Correa. What is your response, sir?
Dr. Eastman. Our approach is comprehensive. There are
migrants who have come into United States custody that have
gotten vaccinations, including and up to this entire CDC
catchup protocol at HHS. We have administered more than 60,000
independent vaccines, predominantly in the----
Mr. Correa. So you are moving in that direction. This
discussion we have had of independent doctors volunteering to
get you up to speed to get there, that is not a factor? You
couldn't use them or you are doing fine on your own?
Dr. Eastman. Medical volunteers is a challenge to medical
organizations, not just ours. Because of the difficulties in
utilizing volunteers and the difficulties with licensure and
administration, we have actually encouraged them to volunteer
in the local Government shelters. CBP has some--and both CBP
and our office have done work to try to vector those volunteers
into places that can utilize them more easily than we can.
Mr. Correa. I am running out of time, Madam Chair, but I
would like to follow up on this issue of the challenges of
having licensed doctors integrated into your system of actually
being able to vaccinate some of these children and deliver
medical services that maybe CBP is not able to deliver because
of, you know, limited capacity.
Finally, Madam Chair, if I can get 30 seconds. Dr. Eastman,
you made a statement that Mexico is trying to improve, on their
side of the Mexican border, some health care. Are we
coordinating at all with the Mexican authorities, in terms of
making sure that health care--disease does not respect a border
but, rather, it addresses both sides. So are we addressing both
sides of the border?
Dr. Eastman. Absolutely, sir. We made a visit. The chief
medical officer made a visit to counterparts in Mexico City
last year. We continue the dialog and we continue to work
together to make the situation as good as possible.
Mr. Correa. Finally, Madam Chair, if I can, I would like to
have written testimony on that later on for review.
Dr. Eastman. We will take the questions for the record.
Mr. Correa. Thank you very much. Thank you, gentlemen, for
being here today.
Miss Rice. Thank you, Mr. Correa.
I now recognize the gentleman from Texas, Mr. Green.
Mr. Green. Thank you, Madam Chair. I greatly appreciate the
opportunity. I thank the witnesses for appearing as well.
To both of you, do you take the President seriously when he
makes the comments?
Mr. Hastings. Sir, I don't know what comments you are
referring to. I generally----
Mr. Green. He is our President. You hear his comments.
Mr. Hastings. When we receive--I don't know what you are
referring to.
Mr. Green. Well, about the wall.
Mr. Hastings. Yes, I think the wall works, from my
experience, from what I have seen it do in the field first-
hand.
Mr. Green. So you take him seriously then?
Mr. Hastings. On the wall.
Mr. Green. On the wall.
Mr. Hastings. I think the wall works.
Mr. Green. So you think Mexico should pay for the wall?
Mr. Hastings. Sir, all I can tell you is the wall works.
Mr. Green. You take the President seriously, don't you?
Mr. Hastings. I can just tell you that I know the wall
works.
Mr. Green. The President said Mexico should pay for the
wall.
Mr. Hastings. I am not involved in funding the wall. I am
just telling you that the wall works.
Mr. Green. Well, you take the President seriously. Let's go
on. How many lives would the wall have saved?
Mr. Hastings. I don't know the answer to that question,
sir. That would be speculative.
Mr. Green. Well, let me ask you this: Are asylees
criminals?
Mr. Hastings. Are the what? I am sorry, sir.
Mr. Green. Are the people who seek asylum criminals?
Mr. Hastings. People who cross the border illegally----
Mr. Green. I didn't ask you about people crossing the
border illegally. You know what an asylee is, do you not?
Mr. Hastings. We have people----
Mr. Green. Do you know the definition of asylee?
Mr. Hastings. I do.
Mr. Green. Then my question is, are asylees, asylees,
people who are seeking asylum, asylees, are they criminals?
Mr. Hastings. We are asking them to go to a port of entry
to receive----
Mr. Green. That has little to do with my question, sir. My
question is, are they criminals? Why are you evading? Why will
you not state what you know to be the truth? Why are you doing
this?
Mr. Hastings. If they cross the border illegally, they have
committed a crime.
Mr. Green. Are asylees, people seeking asylum criminals?
Mr. Hastings. Again, if they cross the border illegally, it
is a crime.
Mr. Green. Where do you find this in the law to support
your position that people who are seeking asylum are criminals?
Are the babies criminals? This is why you treat them the way
you treat them, you perceive them as criminals? Babies aren't
criminals. They have no malice aforethought.
What would you recommend we do to prevent future deaths?
Mr. Hastings. As I have discussed, sir, we are taking a lot
of those actions and have been taking those actions for quite
some time. I think we are taking the right steps now to prevent
further deaths. It will be difficult, as we have explained, to
say we are going to prevent every death.
The people that we encounter on the border, many of whom
have traveled over 2,000 miles or more, some have never seen
health care. Some have never had treatment. Some may not have
eaten or drink anything. But we are running into them,
obviously, at many times in their worst condition and worst-
case scenario, and we are doing everything we can to get them
immediate treatment and aid when that is the case.
Mr. Green. Again, what can we do, meaning Congress?
Mr. Hastings. As I mentioned earlier, I think taking some
of the actions for the double standards for noncontiguous UACs,
that is one; to quit drawing UACs up to our border because we
are unable to return them unless it is Mexico or Canada. Then,
I think, as I mentioned earlier, the Flores fix, being able to
hold everyone together, the entire family in the proper setting
while they go through their expeditious hearing.
Mr. Green. For edification purposes, UAC I find to be a
pejorative.
Mr. Hastings. It is in the law in TVPRA.
Mr. Green. I understand, but I still find it to be a
pejorative. These are children. UACs.
Madam Chair, I am going to yield back the balance of my
time. Thank you.
The Chairman. Thank you.
I now recognize the gentlewoman from Illinois, Ms.
Underwood.
Ms. Underwood. Thank you, Madam Chair, for holding this
hearing to continue this committee's important oversight work
on the humanitarian situation at our Southern Border.
During my 3 oversight trips to the border last year, I saw
and heard first-hand about the need for resources to improve
medical record keeping. As a nurse, I know how important clear
record keeping is when it comes to both patient outcomes and
ensuring health care providers can most effectively do their
jobs.
In response to what I saw at the border, I am so proud that
we based bipartisan legislation last year to provide CBP with
an electronic health record. Just a few days ago, President
Trump signed an appropriations package that includes $30
million in dedicated funding for that electronic health record.
Dr. Eastman, as a physician, can you tell us more about why
EHRs are so important to your work at the border?
Dr. Eastman. Yes, ma'am. Thank you very much. Again, thank
you for passing the funding we need. EHRs serve a very specific
function. They not only allow us to effectively document the
care that is provided, but they also allow us easy access to
the data to do things like quality assurance. It ensures that
we are able to measure the care that we are providing. It
ensures that we are able to assess the quality of that care,
and it ensures we are able to learn lessons from that.
In addition, another system that we intend to develop will
improve our ability to conduct disease and health disease
surveillance, using artificial intelligence techniques that
will trigger the presence potentially of an infectious disease
before a human being could pick it up.
Ms. Underwood. Again, from your perspective as a medical
provider, how do EHRs help providers better communicate about
patient care?
Dr. Eastman. Yes, ma'am. So electronic health records, you
know, they are a complicated topic, but they allow us to
describe the care that we have provided from the point of
apprehension to the point of release from our custody, not only
internally, they don't only help us communicate internally
across multiple settings, but they also allow us to communicate
to external partners.
One of the things that I think is important in this hearing
to mention is that the system that is provided not only
protects migrants, the system that has been put together. It
also protects the integrity of the health care systems in local
communities, that were we not absorbing some of the blow, some
of those local community health care systems would be overrun
by the amount of care that is required.
Ms. Underwood. ICE and ORR already have electronic health
records, and we know that DHS has already begun the process of
building one for CBP. Along with the dedicated funding,
Congress directed DHS to come up with an implementation plan
for this EHR within 90 days.
So, Dr. Eastman, can you give us an update on where DHS is
in this process, and what specific actions have been taken so
far?
Dr. Eastman. Yes, ma'am, I can. Right now we are in the
process, sort-of the first phase of this, which is to identify
some immediate solutions that can integrate the existing
technology that is out there. That work is on-going
immediately. We are also working to plan for the long term.
We have hired a chief medical and informatics officer who
we think has the talent and the expertise to help us build a
system that will not only create an effective customized
solution for us, but will harness our ability to help our
operators do their job more effectively. Everything we do has
to take into account the effects that it has on the individual
operator who is doing the job at the border, at processing
centers, and in ports of entry along the border.
Ms. Underwood. So then what is next? What are the next
phases in the implementation of this EHR?
Dr. Eastman. The next phase is we work our fingers to the
bone to try to get this plan together to come back to brief you
in 90 days as to where we are headed.
Ms. Underwood. Excellent. So you mentioned you hired this
informatics officer.
Dr. Eastman. Yes, ma'am.
Ms. Underwood. What date were they hired?
Dr. Eastman. I will have to take the specifics as a
question, but he has been around 5 or 6 months.
Ms. Underwood. OK. In your medical opinion, why is it so
important to ensure CBP's EHR is interoperable with those used
by ORR and other DHS components?
Dr. Eastman. Thank you, ma'am. Again, we want to make sure
that we are able to provide a seamless picture of all the care
that is provided from the point of apprehension to the point of
discharge. It is important for a provider at ICE to know what
happened upstream of that when the person is--for the care that
is provided under Border Patrol.
Now, that being said, we are working hand-in-hand with the
Border Patrol to make sure that the solutions that we craft
together not only accomplish the goals of the EHR, but also are
user-friendly and don't add to the load, the processing load,
the time that the operators have to put forth to take care of
the migrants in our custody.
Ms. Underwood. Well, I appreciate those operational
benefits, but the other benefit of an electronic health record
is obviously saving lives. We are not missing information. We
are not losing patients, and we are not missing opportunities
to identify infectious diseases or changes in current status.
We are heading into another flu season that is projected to
be severe. Dr. Eastman, you noted in your testimony that you
are working with CDC, ASPR, and other public health agencies to
improve CBP's response. So what specific steps has DHS taken to
strengthen its ability to respond to flu outbreaks at the
border during this current flu season, which we know has been
particularly harmful and deadly for children throughout the
United States?
Dr. Eastman. No question, this flu season, according to the
CDC and other experts, appears that it may be rough. We have
worked hand-in-hand with CBP to help craft enhanced flu control
measures that were crafted with input from experts from the CDC
when they performed a 3-phase assessment along the border, or
very early on in the crisis.
In addition, we have helped provide CBP with the ability to
rapidly diagnose and treat the flu in our facilities at CBP.
Again, that capability is present now in over 40 facilities
along the Southwest Border, and I would challenge folks to find
another law enforcement agency that diagnoses and treats the
flu on the law enforcement side, not the custodial side.
Ms. Underwood. Madam Chair, if I may, just one last follow-
up. What date? Was it new for this flu season that that rapid
capability has been deployed, because it is not our committee's
understanding that that capability was present last year. So
can you----
Dr. Eastman. That has been developing all along through the
course of 2019. So as the contract support has been developing,
that flu capability has been put into place, you know,
continuously over the year.
Ms. Underwood. Thank you so much, Madam Chair, and to our
witnesses for appearing today.
I yield back.
Miss Rice. Thank you. I ask unanimous consent that
Representative Jackson Lee be permitted to sit and question the
witnesses. Without objection.
I now recognize the gentlelady from Texas, Ms. Jackson Lee,
for 5 minutes.
Ms. Jackson Lee. Madam Chair and Ranking Member, thank you
very much for this important hearing, and let me thank the
witnesses for being present today. I think it is very
important.
Mr. Hastings, let me just be clear that you handle law
enforcement operations covering both U.S. Border Patrol and
Customs and Border Protection. Is that----
Mr. Hastings. No, ma'am, just Border Patrol.
Ms. Jackson Lee. All right. So this is a light typo. It has
you in both positions and you are not. I just wanted to clarify
that for the record.
Mr. Hastings. Just Border Patrol, ma'am.
Ms. Jackson Lee. All right. Let me just for the record take
note of the fact that a number of children had died in 2018,
that, in fact, no child had died in CBP custody for the entire
decade before 2018. We lost, in particular, Jakelin, Felipe,
and a number of children that proceeded to get medical care and
who were detained and placed in CBP, and, ultimately, 4 migrant
children passed away while in or shortly after being released
from Federal custody.
Both of you, whether you have children or not, or are
around children or around relatives, acknowledge that the death
of any child is a crisis and tragic. Mr. Hastings?
Mr. Hastings. Ma'am, as I have said earlier, I am a father
and a grandfather, and it is a tragedy.
Ms. Jackson Lee. Dr. Eastman.
Dr. Eastman. Ma'am, I am a parent, and the death of any
child is devastating. But I think it is important to not only
note that it is not just devastating to the parents, but I was
in our facility in Lordsburg and I went and sought our
personnel who tried valiantly to save Jakelin, and, despite
their best efforts, they weren't successful, that is brutal on
the caregivers as well.
Ms. Jackson Lee. Well, you go right to my point, that dying
in the custody of individuals who are basically law
enforcement, but seeing when they are basically committed to
defend and protect alongside of the immigration
responsibilities, their chief responsibilities, that that is
both a crisis and tragic for them to have died in Federal
custody or having just been released. Is that your opinion?
Dr. Eastman. Ma'am, the death of any child, any person in
law enforcement custody is tragic. As you know, you know, law
enforcement officers across this country take very seriously
their responsibility that when we place our handcuffs on
someone, we know we have an ethical, moral, and legal duty to
care for them as well.
Ms. Jackson Lee. A child is particularly vulnerable. I
assume, Mr. Hastings, you agree with that as well, that any
death in Federal custody of a child is tragic and on the brink
of a crisis?
Mr. Hastings. It is tragic, and yes.
Ms. Jackson Lee. The idea of those line officers I call,
and I have been and seen the efforts that they have made during
some very difficult times, buying diapers, getting formula. I
think that should be put on the record.
But I think the key point--and I appreciate some of the
many great steps that Congresswoman Underwood has made. We
traveled together to the border, and several times thereafter.
But my question would be, is it time now, as you present
reports pursuant to the legislation passed, to stand up a very
effective parallel medical system, based on the present
policies of this administration, meaning that asylum is being
denied. They are not being able to access asylum in the way
that they should. There are migrant camps just on the border in
Mexico where disease is rampant, or to be rampant, and so that
means that when they come over, they may be sick.
Do we have an effective medical system that is parallel to
your law enforcement system that can do additional things
besides, you know, the records that are being done and some of
the other aspects of reporting, an effective almost semi-quasi-
health center for these individuals that are coming in?
Dr. Eastman. You want me to start?
Ma'am, I think we have to be very cautious that we
confabulate a health care facility with a law enforcement
facility. We firmly believe at DHS, and it is my personal
belief as a physician that health care is best provided in a
health care setting.
So what we ought to continue to do is to facilitate the
movement of people through our system to the best place to care
for them. For children, that is at HHS. For single adults, that
is in ICE custody. But we have to continue to harden the system
for the times that we face unprecedented demand for care, and I
believe that is exactly what we are doing right now.
Ms. Jackson Lee. Mr. Hastings--Madam Chair, can I just have
a quick follow-up?
Mr. Hastings, your point on this parallel health system?
Mr. Hastings. No, I would agree completely. We want, the
Border Patrol and CBP wants to see UACs, vulnerable populations
out of our custody as quickly as possible, that is what we want
to see, through the proper places where they can receive the
needed care.
Ms. Jackson Lee. Well, let me ask this quick question,
because it might have been misinterpreted that I wanted a
hospital established, and that is not the case.
First of all, the children were not out of your custody as
soon as possible. We have some challenges now with a system
that I helped set up, which is the HHS system, so we will put
that aside.
My point is, is that there be some process that is more
substantial than the law enforcement that can do immediate care
besides putting someone in a police car and trying to rush them
to the next or the nearest hospital.
The question is, do we have an effective emergency response
on-site that can deal with some of these crises, such as one of
the young men, a 16-year-old was found nonresponsive, and there
was not much to deal with his nonresponsiveness. So quickly to
Mr. Hastings and Dr. Eastman.
Mr. Hastings. To answer your question, we are certainly
going in the right direction. As I alluded to earlier, we went
from 3 sectors covered by a medical personnel contract, medical
support personnel, to now 9. They are in our busiest locations
where we need them. We are constantly monitoring to make sure
we have them where we need them, and will continue to do so. On
top of that, we have got 1,500 EMTs that can provide support
and do provide support. I believe that we are taking all the
right steps that we need to.
Ms. Jackson Lee. Dr. Eastman.
Dr. Eastman. Likewise, ma'am. Our strategy is to provide
the right care to the right person at the right time. I believe
we are taking the right steps currently to do that. We, you
know, reserve--and certainly I reserve the right to reassess
this system continuously as conditions change. But it is our
belief at DHS and it is my belief personally that we are moving
in the right direction.
Ms. Jackson Lee. I look forward to that report coming in so
I can understand how the system is working.
Dr. Eastman. Yes, ma'am.
Ms. Jackson Lee. I thank the Chair for her indulgence, and
I yield back.
Miss Rice. Thank you.
The Chair now recognizes the gentlelady from Texas, Ms.
Garcia.
Ms. Garcia. Thank you, Madam Chair, and thank you for your
vote waiving me in to sit on this committee. Thank you to the
witnesses.
I have been following this issue for a great number of
years, beginning with the first influx when I was the chair of
the Senate Hispanic Caucus in Texas. I visited probably about
10 facilities, either under the jurisdiction of CBP or ORR. I
have seen the differences in a lot of the medical protocols, a
lot of the medical care that is provided in all those different
facilities.
I must say that I have never found them to be adequate. I
have never certainly found them to be a clinic or a hospital.
To just borrow the words of my colleague to the right,
Congresswoman Lee, no one is asking for a hospital.
Dr. Eastman, I know you have made reference to you can't
put a clinic in every single, I think you used the word
substation or police department facility. I don't think we are
asking for that either. But I think what we do want is what
many of us have been talking about is the right protocols, the
right screening, to make sure we get on it as quickly as
possible.
I was completely stunned at the lack of any kind of
screening that was done in the New Mexico facility. I know my
colleague Torres Small talked about the one in her district.
That is the one I visited when Jakelin died. I mean, they
literally took a microwave off a table to let her lay there,
because there was nowhere else to put her. This was where they
were waiting until they could get the transportation and the
bus to go on to the facility where perhaps she could get more
treatment. Then, of course, she ended up going to the hospital.
Are you telling me that under today's protocols that has
now changed? I know you said you visited Lordsburg also.
Dr. Eastman. Congresswoman, I am telling you that we do the
absolute best we can under the circumstances we are provided.
In my opening statement, I told this committee and America that
when we were faced with unprecedented demand for care to large
groups----
Ms. Garcia. But, sir, the question is, has that changed in
that facility now? They won't have to remove the microwave to
just put her on that table?
Dr. Eastman. Ma'am, the system----
Ms. Garcia. I mean, they will have a screening method so
that they can detect it sooner to get her on some bus or
somewhere that is----
Mr. Hastings. Ma'am, if I can take that one. So a lot of
our areas have changed. The soft-sided facilities that we have
placed, put in place in many of those areas, including El Paso.
El Paso has a soft-side, soon to have a modular facility as
well, that will give some increased capability and some
increased space that we need. But still, many of our stations
in many of our different locations, they haven't changed. They
were built for a completely different demographic. They have
not changed. We have added as much as we can in those locations
in the way of food, health care products, those types of
things, but, I mean, they were not built to house for long
periods of time at all.
Ms. Garcia. Well, I appreciate your answering, but I still
would like Dr. Eastman to.
Dr. Eastman. Just to be clear, just to be clear, the system
that is in place today, by virtue of the growth and the hard
work of a lot of people across the Government and CBP bears
little resemblance to what it looked like at Christmastime
2018.
Ms. Garcia. But I am asking specifically about some of
these remote stations, because many people are using that since
a lot of the port of entries that they were used to using.
They, frankly, aren't even allowed to get even close enough to
make entry. They are using other more remote areas.
So the question is, has that one now been improved? If
someone presented themselves with high fever, you know, chills,
the typical flu symptoms----
Dr. Eastman. So I will give you two tangible examples.
Ms. Garcia [continuing]. Would that person be put on the
same microwave table?
Dr. Eastman. I will give 2 tangible answers to answer your
question. First of all, the expansion of contracted health care
allows the Border Patrol to use their 1,500 EMTs in the role
they were designed, which was not to be screening personnel
inside facilities, but to be outside in the field caring for
our personnel and anyone else they encountered.
The second thing----
Ms. Garcia. So that is a no?
Dr. Eastman. Ma'am, the second thing is that there is now
contracted support in multiple locations along the border, and
we will take for the record to get you back the exact details
of where that contracted support exists today.
Ms. Garcia. So along the entire border of Texas now, there
is some screening protocols to ensure that this would never
happen again?
Dr. Eastman. Yes, ma'am. The tiered approach that I
described earlier in this hearing is in place all along the
Southwest Border.
Ms. Garcia. All right. What about the medical assessment,
or screening, are there any in place for the folks that are
coming through in the Migration Protection Protocols, the
Remain in Mexico program? Are they screened at all? Because I
am hearing that there is a lot of people on the other side of
the border that have been turned away under this new program
that are very, very sick.
Dr. Eastman. The care that occurs south of the United
States' Southern Border is outside my scope, and I am not sure
what is being done on the Mexican side of the border.
Mr. Hastings. But, ma'am, so I would add they will go
through medical clearance prior to us putting them into MPP and
returning them. So they will go through this same process prior
to being returned under MPP.
Additionally, there is a map up there that kind-of outlines
where we are today as far as those 40 different locations that
we have contract medical service. I realize we are looking at a
bunch of dots on a map, but the fact is over 300 individuals on
duty at any given time providing that additional medical
support through our agents in the field. That map, we can't
see----
Ms. Garcia. So you are telling me that although they are
being turned away to go back to Mexico, that you do screen
them?
Dr. Eastman. Can I just take that one, sir?
Mr. Hastings. Go ahead.
Dr. Eastman. The approach to the health interview and
medical assessment applies to everyone that is in our custody,
with the parameters we described earlier.
Ms. Garcia. Well, these folks are not in custody, sir. You
are turning them away.
Dr. Eastman. Ma'am, if they are in our custody, they get
the assessments and the care that was described. As I said, it
is outside my scope to know what happens to them south of the
border.
Ms. Garcia. Madam Chair, obviously, apparently the witness
is not understanding the question. I am talking about the folks
that are being turned away under the Remain in Mexico program.
Miss Rice. You are going to have an opportunity to ask that
again.
Ms. Garcia. Thank you.
Miss Rice. Mr. Ranking Member, do you have any additional
questions?
Mr. Higgins. Yes, Madam Chair.
Madam Chair, before I ask my second round of questions, I
ask unanimous consent to submit the Homeland Security Advisory
Council final report by the CBP Families and Children Care
Panel, which was published in November 2019. I ask unanimous
consent to submit it for the record.
Miss Rice. So received.*
---------------------------------------------------------------------------
* The information has been retained in committee files and is
available at https://www.dhs.gov/sites/default/files/publications/
fccp_final_report_1.pdf.
---------------------------------------------------------------------------
Mr. Higgins. Mr. Hastings, would you like to clarify the
medical screening that all human beings that cross the border
and come in our custody, regardless of what program they are
then subject to, would you clarify for my colleague, Ms.
Garcia, and for the rest of the committee?
Mr. Hastings. Thank you for the opportunity, sir. So that
is correct. Ma'am, anyone that comes into our facility,
regardless of what program or initiative that they are going
into, will go through all of that medical assessment, medical
screening, and interview.
Mr. Higgins. So are you clarifying that minors, including
children, all individuals that are returned to Mexico under the
program prior to being returned receive medical screening?
Mr. Hastings. Prior to return, we still have to process
them. So during processing, we go through that.
Mr. Higgins. What if they are sick? Let me extend my
colleague's line of questioning here. What if they are sick?
Mr. Hastings. Then they will go to the hospital or the
appropriate medical care.
Mr. Higgins. If the screening determines that they are
sick, to the extent that they need professional medical
attention, we are getting them that medical attention before we
send them back to Mexico?
Mr. Hastings. Yes, as evident by the 26,000 we took to the
hospital last----
Mr. Higgins. That is our policy across the border or only
at one location?
Mr. Hastings. That is across the border, sir.
Mr. Higgins. Thank you, sir, for clarifying that.
Dr. Eastman, in your testimony you mentioned the close
working relationship between CBP and the Office of DHS Chief
Medical Officer. Can you go into a little more detail, sir,
about the specialized nature of your team's assistance to
Customs and Border Protection? Also, based upon your
observations, how committed has CBP leadership been to
expeditiously address in-custody medical capabilities?
Dr. Eastman. Sir, with regards to your first question--and
thank you--the relationship literally is hand-in-hand. Our
office and the Border Patrol and CBP communicate constantly. In
fact, the CBP senior medical adviser is an employee from our
office that is embedded into CBP to help facilitate these
issues. The relationship is hand-in-hand, and we communicate
literally at multiple levels probably, it is safe to say,
daily.
With regards to your second question, my direction has been
clear and our direction has been clear from every leader in the
Department, whether that is at DHS or CBP, that the direction I
was given and we----
Mr. Higgins. What about the direction that you have
received from up chain, all the way to the top?
Dr. Eastman. Yes, sir. The direction I have received has
been clear and has been unanimous: Do the right thing.
Mr. Higgins. Do you feel like the Executive branch and our
President is committed by their leadership to expeditiously
address in-custody medical capabilities?
Dr. Eastman. Sir, I have not spoken to him directly, but my
directions come from the Secretaries and the commissioners of
CBP that I have worked with, and it has been clear, loud, and
unanimous: Do the right thing, break down barriers, and take
good care of the people in our custody.
Mr. Higgins. That message has been pushed throughout the
chain of command?
Dr. Eastman. Yes, sir. It has been unanimous and loud and
clear from everyone I have worked with.
Mr. Higgins. Thank you for your clarification.
Madam Chair, thank you for the second round of questioning,
and I yield.
Miss Rice. Thank you, Mr. Ranking Member.
I now recognize the gentlewoman from Illinois, Ms.
Underwood.
Ms. Underwood. Thank you, Madam Chair.
I have a couple follow-up questions, based on what we have
heard today and what was submitted in the written testimony. In
Mr. Hastings' written testimony on page 6, I am just going to
read a couple statements. It says: ``The enhanced medical
directive ensures that CBP will sustain enhanced medical
support capabilities, with an emphasis on children less than 18
years old. These include a health interview upon arrival at a
CBP facility.''
Mr. Hastings, can you further delineate whether those CBP
facilities include all Border Patrol stations?
Mr. Hastings. It does include all Border Patrol stations,
yes, ma'am.
Ms. Underwood. OK. So then just to circle back on what was
just recently discussed by Ms. Garcia and Mr. Higgins, then if
it includes the Border Patrol stations for individuals that are
brought into apprehension, with the idea that they will be put
into this Migrant--the MPP policy, then you consider that under
U.S. custody, correct? Because they are being----
Mr. Hastings. That is correct, ma'am.
Ms. Underwood. So those individuals all get a health
interview?
Mr. Hastings. That is correct.
Ms. Underwood. OK. If those individuals are seen as having
some kind of medical flag, to use a casual term, then they will
get a medical assessment?
Mr. Hastings. That is correct, yes, ma'am.
Ms. Underwood. Dr. Eastman, can you confirm that that is
happening in all facilities?
Dr. Eastman. Absolutely, ma'am. In the locations where we
don't have contracted medical support, yes----
Ms. Underwood. Correct.
Dr. Eastman [continuing]. As that continues to develop, we
utilize local resources to get that assessment. So if the
interview occurs and if folks need health care, and we don't
have it there, they will get it in a local system.
Ms. Underwood. OK. So just to reiterate, the individuals
that are coming to the United States that under current policy
under DHS, you-all want to send them back to remain in Mexico
or go through the MPP, and they present with a health care
issue, you are saying that they are getting both an interview
and a screening, and if at that local facility, they don't have
the medical staff on-site to do the screening, you-all are
sending them externally to get that medical assessment
completed?
Dr. Eastman. If they have a medical need, we will certainly
utilize the local health care system, yes, ma'am.
Ms. Underwood. OK. OK. My follow-up question then is, on
page 4 of Mr. Hastings' testimony, he says that currently each
day, there are approximately 300 contracted medical
professionals engaged at more than 40 facilities along the
Southwest Border, providing 24/7 on-site medical support, and
that support is now available at all 9 Southwest Border USBP
sectors, so U.S. Border Patrol sectors, and all 4 Southwest
Border OFO field offices.
So, based on that, would you then consider there to be 100
percent coverage?
Mr. Hastings. No, ma'am, I would not. So, as I mentioned
earlier, we believe we have about 10 more locations that we
need to cover that we are working rapidly to get coverage now.
How we determined where this went was where the highest flow of
vulnerable populations was.
Ms. Underwood. I understand.
Mr. Hastings. Where we had the least medical support in our
nearest areas, and the highest flow rate that we were seeing.
We have about 10 more locations that we are looking to expand
to now still.
Ms. Underwood. Do you have the current funding to support
that expansion?
Mr. Hastings. We do have the current funding to support
that, yes, ma'am.
Ms. Underwood. OK. So then the numbers that are submitted
in your testimony are current as of what date? So these
individuals and locations were staffed as of what date?
Mr. Hastings. December, end of December 2019.
Ms. Underwood. OK. Thank you, Madam Chair, I yield back.
Miss Rice. Thank you. Where are the 10 additional
locations?
Mr. Hastings. I would have to look at the chart, ma'am. I
can get back to you. I don't have the chart in front of me.
Miss Rice. OK, thank you. I now recognize the gentle woman
from Texas, Ms. Garcia.
Ms. Garcia. Thank you, Madam Chair. Just a quick follow-up.
Mr. Hastings, what is the average stay these days for a child
in custody?
Mr. Hastings. So that varies, ma'am, from day to day, hour
to hour, but on average, the average time in our custody right
now is approximately 39 hours, the last time I looked.
Ms. Garcia. Thirty-nine hours?
Mr. Hastings. The last time I looked, yes, ma'am. Juveniles
are leaving our custody quickly since HHS is funded.
Ms. Garcia. OK. Do you remember what month that was? I
mean, that is obviously not the numbers I am seeing. So----
Mr. Hastings. It has been a while since I have looked at
the TIC time, it is one of--the time in custody time, that is
one of the many variables that we look at, but the point being
is----
Ms. Garcia. It is shy of 2 days.
Mr. Hastings. Pardon me?
Ms. Garcia. It is shy of 2 days.
Mr. Hastings. We are doing very well with individuals
getting----
Ms. Garcia. Right. Well, let me ask you this. I don't know
the age of your grandchildren, but would you be comfortable
with having your grandchild in custody in one of your own
facilities for 39 hours?
Mr. Hastings. I wouldn't want--I don't want any child in my
facilities for that long, ma'am. For----
Ms. Garcia. But would you be comfortable----
Mr. Hastings. I am sorry. In the crisis. For right now, for
39 hours, I trust that our employees are taking good care of
the detainees that they are charged with oversight.
Ms. Garcia. So you would be comfortable if your grandchild
was there?
Mr. Hastings. I think we are providing--we are doing very
well providing proper services for all those in our custody
right now. During the crisis, no, I wouldn't. I don't want them
in our----
I wouldn't want my granddaughter in custody anywhere, but I
think we are doing the best we can with everything we have out
there on the border right now, with all the improvements that
we have made and how quickly we are getting these unaccompanied
alien children out of our custody.
Ms. Garcia. Right. What about you, Dr. Eastman? I know you
mentioned--I don't know if you have children or grandchildren
or little nieces and nephews like I do, but would you feel
comfortable with a member of your family being in custody in
your facility?
Dr. Eastman. With no offense to Chief Hastings, ma'am, I am
a little young for grandchildren, but I will tell you----
Ms. Garcia. I never make assumptions, I have learned in
this business.
Dr. Eastman. Right, I understand. I understand, ma'am. I
want to be clear with Chief Hastings, that it would be my
preference that we don't ever hold children in our custody.
However--however----
Ms. Garcia. Well, that certainly is my preference in that a
child has not committed any crimes, as my colleague from
Texas----
Dr. Eastman. Well, again, however--well, let me be clear
from my perspective as a physician, that we provide our care
irrespective of circumstances. It does not matter to us what
they have or have not done. Our care is provided to every human
being in our custody the same, no matter what the circumstances
are.
Ms. Garcia. Right.
Dr. Eastman. To answer your question, ma'am, I would be
very comfortable with my children receiving care in this system
if it were necessary, and I know that we are going to continue
to do everything we can to improve it every day.
Ms. Garcia. Right. Let me follow up on my colleague Mr.
Correa's questions. Like him, I also serve on the subcommittee
of Judiciary Committee on immigration. He was asking about
volunteer doctors. I know that--I am from Houston. We have a
large medical center, which means we have a lot of doctors
around. Many of them do a lot of good volunteer work in a
number of areas and been able to do missions abroad.
They have mentioned to me that, you know, they have tried
to help and tried to volunteer, tried to even bring especially
the flu vaccine to some facilities. I mean, what is the real
beef if they are Texas facilities or Texas doctors and they are
willing to help, why wouldn't you allow them to help?
Dr. Eastman. So, just to be clear, ma'am, I am a Texas
doctor, as well.
Ms. Garcia. I know that, I saw your resume.
Dr. Eastman. But the provision of volunteer medical support
presents challenges not just to the Department of Homeland
Security but to medical organizations in this country, in every
State.
So while we sometimes have difficulty with the licensure
and administrative requirements, we certainly--and we have done
this--we have tried to vector volunteers who want to provide
that help, to some of the other locations that aren't as
fortunate to have medical support like we are, like the NGO
shelters along the Southwest Border. So when we have had Texas
volunteers, we have tried to vector them into the Texas NGO's
that need help.
Oftentimes, while that is not my role as the DHS senior
medical officer, we have been thrust into that, because in many
ways, we are the intermediary between those medical volunteers.
For example, you are from Houston. I talk to Dr. Maddox almost
daily, and we talk routinely about things like this.
We talk to--and one of the things I think that is really
important is that during the course of this crisis, we have
worked with State and local health departments and doctors all
across the Southwest Border, and it has been a hand-to-hand,
direct, face-to-face meetings and working together to solve
problems as they arise.
We have tried to be the best partner possible to the State
and local health departments along the Southwest Border, and I
think some of you saw evidence of that when you came and
visited the border and saw some of those interactions. We will
continue to do that, you have got my word. We are going to
continue to try to the best partner as possible.
Ms. Garcia. What impediments or challenges are there, and
would there be anything that we can do in terms of legislation,
to be able to provide, you know, better access to volunteer
doctors?
Dr. Eastman. Yes. My suggestion, ma'am, is that we take
this off-line and we work together because the provision of
volunteer services in disasters in this--volunteer medical
services in disasters in this country is something that we are
interested in. It is a tiny bit outside of scope of this
hearing, but I would love to work together with you to try to
help solve this problem on an actual basis.
Ms. Garcia. Well, I think it is in the scope not only for
this hearing that is focused on CBP, but also we have the same
challenge and even volunteers who want to help children that
are in our facilities, even something as simple as taking them
to the movies.
I mean, some of these facilities won't even allow people to
come visit the children in any way to try to assist in terms
of, particularly their mental health, well-being. So, sure, we
will take it off-line, and Dr. Maddox is a good friend, so we
will wake it a three-way call.
Dr. Eastman. He would love that, ma'am.
Ms. Garcia. Thank you. Thank you. I yield back.
Miss Rice. Thank you.
Let me just say that I--and I think I can speak for my good
friend, Mr. Higgins, the Ranking Member, but I want to thank
Mr. Hastings and Dr. Eastman for coming today.
There are people in positions above you who don't show up,
who don't answer the call, which is their duty. So the fact
that you two showed up and took some difficult questions, you
know, I am grateful. I am very grateful because you could have
done what they did. We are well within our Constitutional
obligation of having a role in oversight.
I want to thank the Ranking Member on this subcommittee
because we have been trying to address this issue. Before
anyone is a Republican, a Democrat, black, white, male, woman,
we are all human beings and we are all Americans. I know that I
think I can speak for everyone in this room and certainly on
this committee that even one death in custody is a tragedy.
Dr. Eastman, I remember meeting you before you even got the
position, because it was one of the issues we tried to address
is how quickly we can bring qualified people like you in to
help solve this problem. I want to thank you. I know that you
have had contact with my colleague, Ms. Underwood, who has a
medical background, and it is relationships like this that are
going to help us all address these tragedies and ensure that
they don't happen again.
These are children who are being brought here for a better
life, which is all any of us want for our children.
Dr. Eastman. Thank you, madam.
Miss Rice. I thank the witnesses for their valuable
testimony and the Members for their questions.
The Members of the subcommittee may have additional
questions for the witnesses, and we ask that you--some of which
we spoke about during the questioning, and we ask that you
respond as expeditiously as possible in writing to those
questions.
Without objection, the subcommittee record shall be kept
open for 10 days.
Hearing no further business, the subcommittee stands
adjourned.
[Whereupon, at 12:12 p.m., the subcommittee was adjourned.]
A P P E N D I X
----------
Questions From Chairwoman Kathleen M. Rice for Brian Hastings
Question 1a. On December 30, 2019, CBP issued an Enhanced Medical
Support Directive, to among other things, mitigate risk to and sustain
enhanced medical efforts for migrants in custody along the Southern
Border.
Has CBP developed training for CBP personnel to identify children
in distress during initial encounter as required by the Directive? If
so, please provide documentation of this training and the number of CBP
personnel by sector and field office that have completed this training
as of January 14, 2020.
Answer. Response was not received at the time of publication.
Question 1b. The Directive states that Border Patrol and OFO will
ensure a medical assessment is conducted on certain categories of
detained migrants, subject to availability of resources and operational
requirements. What is the threshold level of resources needed to ensure
that medical assessments are provided to the migrant categories
identified in the Directive?
Answer. Response was not received at the time of publication.
Question 1c. What oversight mechanisms does CBP have in place to
ensure the directive is followed as required and on a consistent basis?
Answer. Response was not received at the time of publication.
Question 2. In your oral testimony, you noted that $1.1 billion of
the Emergency Supplemental Appropriations for Humanitarian Assistance
and Security at the Southern Border Act of 2019 was allocated for
humanitarian support, border operations, and mission support. As of
January 14, 2020, how much of this funding has been allocated and how
much of these funds remain unspent and available for use by CBP?
Answer. Response was not received at the time of publication.
Question 3. You stated in your written testimony that many of the
improvements made to address the migrant crisis rely on the existence
of emergency supplemental funds. What funding level is required for CBP
to implement the Directive's requirement that every migrant under the
age of 18 will receive a health interview? What funding level is
required to ensure that resources are available to ensure that a
medical assessment is conducted on all children under the age of 12
held in CBP custody and the other categories of migrants noted in the
Directive?
Answer. Response was not received at the time of publication.
Question 4a. In your testimony, you noted that CBP currently has
medical support professionals engaged at facilities along the Southern
Border.
What is the staffing breakdown of CBP's medical contract, including
the number of contracted professionals, their job titles, and job
descriptions?
Answer. Response was not received at the time of publication.
Question 4b. In what locations on the Southern Border are medical
support professionals deployed to and what is CBP's rationale for
staffing the number of medical professionals at these locations?
Answer. Response was not received at the time of publication.
Question 4c. What funding levels are required to ensure
implementation of this contract along the Southern Border?
Answer. Response was not received at the time of publication.
Question 4d. How many trained emergency medical technicians and
Border Patrol agents certified as emergency medical technicians operate
on the Southern Border?
Answer. Response was not received at the time of publication.
Questions From Chairman Bennie G. Thompson for Brian Hastings
Question 1. In your written testimony, you noted that the Enhanced
Medical Directive ensures that CBP will provide a health interview for
all migrants less than 18 years old. What questions will be asked to
migrants during this interview and will CBP personnel be permitted to
ask additional questions if the circumstances of a migrants' health
warrant?
Answer. Response was not received at the time of publication.
Question 2. The Directive states that CBP Form 2500 will be used to
conduct health interviews. Please provide the committee with a copy of
this form. Does CBP plan to periodically review and amend this form if
circumstances warrant changes to it?
Answer. Response was not received at the time of publication.
Question 3. The Directive states that it applies to both CBP
steady-state and surge operations. This Directive also appear to apply
to crisis operations when additional interagency resources and support
will be required. What is CBP's criteria for determining ``major surge/
crisis-level operations'' and what additional agency resources will CBP
seek to ensure requirements within the Directive are met?
Answer. Response was not received at the time of publication.
Question 4. In your testimony, you stated that CBP would notify
Congress if they decide not to follow the Directive based upon
operational requirements. What exact criteria will CBP assess to
determine whether resources are, or are not, available to abide by the
Directive? Who within CBP will make the decision that the Directive
must or must not be followed based upon the previous assessment?
Answer. Response was not received at the time of publication.
Question 5. Please provide the committee with the written
guidelines for notifying Congress when CBP determines that the
Directive will or will not be followed.
Answer. Response was not received at the time of publication.
Questions From Honorable Sylvia Garcia for Brian Hastings
Question 1. What is CBP's policy for providing medical treatment to
migrants that CBP agents identify as sick that are subjected to the
Migrant Protection Protocols?
Answer. Response was not received at the time of publication.
Question 2. What are CBP's written protocols in place to protect
CBP personnel and migrants from the spread of infectious diseases, such
as the flu, inside processing centers, Border Patrol stations and ports
of entry? Please provide these documented protocols.
Answer. Response was not received at the time of publication.
Questions From Chairwoman Kathleen M. Rice for Alexander L. Eastman
Question 1. What is DHS policy for providing medical treatment to
migrants that are subjected to the Migrant Protection Protocols? What
kind of engagement is done with the Government of Mexico?
Answer. Response was not received at the time of publication.
Question 2. What are DHS protocols to protect DHS personnel and
migrants from the exposure of illnesses, such as the flu, inside
processing centers, Border Patrol stations and ports of entry? Please
provide these documented protocols.
Answer. Response was not received at the time of publication.
Questions From Honorable Lauren Underwood for Alexander L. Eastman
Question 1. What is the status of implementing an electronic health
record (EHR) system for migrants on the Southern Border?
Answer. Response was not received at the time of publication.
Question 2. What is the estimated time to complete this EHR system?
Answer. Response was not received at the time of publication.
Question 3. What entities, including Federal, State, local, and
private stakeholders have DHS engaged with on implementing this EHR
system?
Answer. Response was not received at the time of publication.