Medicine Must Defend Detainee Health Where the Law Has Failed to Do So

In an immigration detention system known for its disregard of even basic needs, Francisco Castaneda’s case stands out as a prime example of the US government’s indifference to health and human rights.In March 2006, Mr. Castaneda, an immigrant from El Salvador, was detained by immigration officials of the US Department of Homeland Security.? At that time he had a small lesion growing on his penis, for which he promptly requested medical attention from detention authorities.? Over the course of the next year, as the lesion grew larger and more painful and Mr. Castaneda additionally developed a lump in his groin, no fewer than four health professionals who examined him ordered a biopsy to determine definitely whether Mr. Castaneda suffered from the cancer they suspected he had.By late 2006, the lesion frequently bled and produced discharge, and caused Mr. Castaneda difficulty urinating and even sleeping. Despite this, US Public Health Service officials, who had the final say on referring Mr. Castaneda for specialist care outside the detention center where he was held, refused to authorize the biopsy. Their reason?? They said it was an “elective” procedure.Tragically, and outrageously, a biopsy was finally approved after a fifth recommendation. Before it could be performed, however, Mr. Castaneda was suddenly released from detention. This action freed the US Department of Homeland Security from responsibility for Mr. Castaneda’s care.Access to health care came too late for the former detainee. Despite receiving treatment after his release for what was, in fact, penile cancer, Mr. Castaneda passed away in February 2008.The United States Supreme Court this week released a decision in the case that Mr. Castaneda’s family has pursued against the officials who callously denied him care.? Despite the government’s acknowledgement in March 2008 that its officers’ decisions were medically negligent, the Court agreed with the government that US law does not permit the Castaneda family to sue the individual medical personnel who were responsible for denying the biopsy requests.The Supreme Court’s timing is ironic, coming as it does within weeks of the US Congress passing landmark health care legislation designed to enhance the public’s access to health care services. More than 30 years ago, the Court held that health care for prisoners is a Constitutional right – protection that exceeds anything that the Court has recognized for those of us who walk freely on the street. A systematic disregard for a detainee’s health that puts his life at risk also violates US obligations under human rights treaties, an issue not before the Court in this case and therefore not addressed.There are two critical lessons to take away from this senseless loss of life: there is a dire need for a robust program of community-based alternatives to immigration detention, and health care delivery to immigration detainees must be reformed.If Mr. Castaneda had been released into a community-based detention-alternatives program much sooner, he could have obtained medical care that could have saved his life, or at least have had more time with his family. Release under safeguards, into community-based, cost-effective programs that provide counseling and help with immigration proceedings, best serves the interests of both the government and immigrants with no history of violence and well-established roots in the community.Reform of immigration detention health care must also occur without delay. While the Obama Administration works on comprehensive reform to civil detention health care, immigration officials should look to the correctional community for an interim health care model. Immigration detention centers should be required to obtain and maintain professional accreditation for medical operations from an entity such as the National Commission on Correctional Health Care.? Monitors from the community—either state health authorities or other organizations with expertise—should participate in ongoing oversight over medical care provided by immigration detention centers in their jurisdictions.As Mr. Castaneda himself said in testimony to a House committee in October 2007, he and his allies sought justice

for the many others who are suffering and will never get help unless [Immigration and Customs Enforcement] is forced to make major changes in the medical care provided to immigrant detainees.

Health professionals can and must do more to speak out against the conflicting loyalties to which detention health authorities are subject, and the failure of detention medical personnel to uphold their ethical duties toward patients such as Mr. Castaneda. Health professionals can also authoritatively advocate release on appropriate safeguards, and access to care in the community, for immigrants in deportation proceedings. While the law has failed the Castaneda family, the health professions must not.

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