Substandard Medical Care in Civil Immigration Detention

Abstract

Abstract

Photo ID 453768931 © Andrei Dodonov | Dreamstime.com Abstract People in United States civil immigration detention routinely receive medical care that falls below the standards set by international human rights law and the US Constitution. Drawing on agency death reviews, a county medical examiner’s report, and Inspector General findings, this article documents a recurring pattern: care delayed or withheld; patient refusal statements presumed or accepted without inquiry; and no functioning avenue for complaint or appeal. Two deaths in ICE custody, nine years apart, show the same failures and the same lack of consequences. The problem is not primarily a financial shortfall, but the absence of binding standards, independent oversight, and meaningful accountability. Detention medical standards are agency-issued rather than statutory; inspections are conducted by the agency and its own contractors, and payment is not tied to health outcomes. The remedy is enforceable, condition-based care standards with independent oversight, that could be modeled on federal nursing-home law, alongside genuine informed-consent requirements and a grievance process that works. Introduction On any given day, the United States holds tens of thousands of people in civil immigration detention across more than a hundred facilities. Immigration detainees are civil detainees held pending the resolution of an immigration matter, not people serving a criminal sentence. A growing clinical literature documents systematic failures in their medical care.[1] Even the death count is contested. The Guardian’s verified tally recorded thirty-two deaths in ICE custody in 2025, the deadliest figure in more than two decades; ICE’s own published notices yield a lower figure; and federal fiscal-year counts are lower still. Journalists counted more than fifty deaths between January 2025 and May 2026.[2] This article argues that the medical care provided in civil immigration detention routinely falls below the standards ICE itself has adopted, and that its failures violate both the United States’ obligations under international human rights law and the constitutional protections owed to anyone the state holds in custody. The cause is not simply financial. It is the absence of binding standards, independent oversight, and meaningful accountability. When a detainee declines treatment, the refusal is accepted without inquiry, and the duty of care is treated as discharged. Yet when a detainee requests or clearly needs medical care, they do not consistently get it. Consent under these conditions may reflect administrative convenience rather than the will of the patient. This system has resulted in failures to address infections before they spread, and failures to treat both life-threatening and chronic diseases, and ultimately, preventable deaths of detainees.[3] The Documented Pattern of Substandard Care Kamyar Samimi, a sixty-four-year-old lawful permanent resident from Iran, died in 2017 after sixteen days at a privately operated detention facility in Colorado while withdrawing from long-term methadone use.[4] ICE’s own review of his death catalogued twelve violations of the agency’s written medical standards. Nurses recorded his vital signs twice a day instead of every eight hours as ordered and gave him fewer than half of the prescribed withdrawal medications. The facility physician never physically examined him, no one transferred him to an emergency department, and most of the nurses believed he was faking.[5] After listing these failures, a review concluded that the deficiencies “should not be construed as contributory to the detainee’s death.”[6] Emmanuel Damas, a fifty-six-year-old Haitian national, died on March 2, 2026 of complications of an infection that began in his teeth and spread to his chest after months at the CoreCivic-operated Central Arizona Florence Correctional Center.[7] Three accounts of his death now exist, and they do not agree. ICE’s detainee death report states that Damas received regular medical and dental evaluations and declined recommended tooth extractions.[8] The Maricopa County Medical Examiner, working largely from the facility’s own records, reconstructs a more detailed timeline. A dental examination in October 2025 identified a tooth requiring extraction at which point Damas was placed on a waiting list. Records state he was offered an extraction roughly three months later and declined because the tooth no longer hurt, and declined a second time in mid-February. They also document a refusal days later to be moved to the medical unit when he complained of a sore throat and abdominal pain. He was hospitalized on February 19 for respiratory failure and septic shock, and died eleven days later from necrotizing mediastinitis with abscesses in his neck and throat secondary to severe dental disease.[9] His family’s account is also different. They state Damas reported severe tooth pain to staff in mid-February, received only over-the-counter medication, and was sent to a hospital only after days of visible deterioration. The family’s counsel attributes his death to the failure of CoreCivic and ICE staff to provide timely, basic care.[10] These accounts cannot be reconciled. These are not isolated cases. At the Irwin County Detention Center in Georgia, advocates documented shredded medical-request forms, one detainee denied HIV medication for three weeks after five requests to see a doctor, and another denied breast-cancer medication for six weeks.[11] None of this is new; a congressional subcommittee flagged the same categories of failure in 2008.[12] Furthermore, a grievance process exists on paper, but complaints go unanswered, are lost, or are met with retaliation including placement in isolation.[13] Accountability is narrowing rather than expanding. In 2026, ICE revised its death-reporting directive to remove deaths occurring within thirty days of release from custody, shrinking the count by which the system’s failures might be measured.[14] Standards Without Enforcement Immigration detainees are held in a patchwork of facilities, including federally owned processing centers, privately operated contract facilities, and county jails operating under intergovernmental agreements. No statute or regulation sets binding standards for medical care in ICE detention.[15] The federal regulation directly addressing medical care for DHS detainees, 42 C.F.R. § 34.7(a), is permissive rather than mandatory: it provides that a detained person may be given medical, surgical, psychiatric, or dental care by HHS under an interagency agreement with DHS reimbursing the cost. It establishes a mechanism and a payer, not a standard of care. [16] Instead, medical care is governed by agency-issued detention standards (Performance-Based National Detention Standards (PBNDS)) that require medically necessary care, professional interpretation for people with limited English proficiency, and documented informed consent before non-emergency procedures. However, these standards are applied unevenly. Some facilities follow older versions, some follow none, and in some contracts, it is unclear which version applies. Oversight does not close the gap. The DHS Office of Inspector General has found that ICE’s inspections, conducted by offices within the agency and by its contractors rather than by independent investigators, do not lead to sustained compliance or systemic improvement; treatment and care at inspected facilities violated the agency’s own standards; and ICE does not use the contracting tools it has to hold facility operators accountable for failing to meet performance standards.[17] Many contracts have no expiration date, removing the leverage that the risk of losing a contract might offer. The result is a body of standards detailed enough to describe good care and toothless enough to make its absence cost nothing. Human Rights Obligations The United States helped draft the Universal Declaration of Human Rights, which recognizes a right to medical care and to security in sickness.[18] It has ratified the International Covenant on Civil and Political Rights, which prohibits cruel, inhuman, or degrading treatment and requires that people deprived of liberty be treated with humanity and respect for their inherent dignity.[19] It has also ratified the Convention Against Torture, which defines torture to include the intentional infliction of severe physical or mental suffering by or with the acquiescence of a public official. Care withheld to the point of sepsis or invasive procedures performed over a competent patient’s objection can meet that definition.[20] Additionally, as a party to the 1967 Refugee Protocol, the United States has agreed to treat those who seek refuge humanely.[21] These are not aspirations. They are commitments the United States has ratified, and inconsistent with the documented treatment of people in civil immigration detention. Constitutional Protections A civil detainee may not be punished at all. Under Bell v. Wolfish, a condition imposed on someone who has not been convicted amounts to unconstitutional punishment when it bears no reasonable relation to a legitimate government purpose.[22] The distinction is between regulation and punishment: conditions reasonably related to a legitimate governmental objective, such as ensuring appearance at removal proceedings or maintaining facility security, are permissible, while conditions not reasonably related to any such objective amount to punishment. Denying a detainee prescribed medication or leaving an infection to become septic serves no such purpose. Where the failure is deliberate, it is punishment imposed on a person the state has no legal authority to punish. The due process clause sets the standard more directly. Because civil immigration detainees are not convicted prisoners, their medical-care claims arise under the due process clause of the Fifth Amendment. People in c