Pediatric Group Presses Border Patrol to Consult Disaster-Planning Experts

U.S. Customs and Border Protection is assessing how it treats children after two deaths in the agency’s custody.

An asylum-seeker feeds her son as they are taken into custody by U.S. Border Patrol agents after crossing the U.S. border wall into San Diego on Dec. 27, 2018.
AP Photo/Daniel Ochoa de Olza
Jan. 2, 2019, 8 p.m.

After two children died last month in Border Patrol custody, the federal government is reviewing its medical treatment of children in stations along the border and has, for the first time, reached out to the American Academy of Pediatrics to gain outside expertise.

Experts and advocates say these facilities currently lack personnel with the medical expertise to take care of children. Pediatric medical experts’ access has been limited, and the agency in the past has rebuffed pushes to hire child-welfare experts, the advocates told National Journal.

Now, Customs and Border Protection Commissioner Kevin McAleenan is reaching out to the American Academy of Pediatrics to better address the needs of children in CBP custody. McAleenan and the pediatrics association are planning to connect AAP’s experts on disaster planning with officials from the Centers for Disease Control and Prevention and CBP, according to AAP President Colleen Kraft.

Kraft, who spoke with the commissioner on New Year's Eve, said AAP wants to focus on “policies and protocols that we could review with them that would keep the medical needs of children in mind as they’re coming through our Southern border.”

Kraft said the academy wants to help CBP best implement CDC protocols for caring for children in disaster situations. “We would advise on screening, triage, ongoing management, changes in the facility, or the placement of children and families based on a child's medical condition, quarantine for infectious diseases, etc. This is all part of the CDC, but the AAP brings a special focus on children,” she wrote in an email to National Journal.

The next step, Kraft said, is to connect the academy’s disaster-planning experts with CDC and CBP officials on McAleenan’s team. She added that McAleenan was supportive of letting the academy’s experts visit the border, but a visit has not been approved or scheduled yet.

The death of an 8-year-old boy late on Christmas Eve, weeks after a 7-year-old girl died in Border Patrol custody, laid bare the dearth of pediatric medical expertise in these facilities, Kraft said. The group has not been allowed in to see the treatment children are receiving, she noted.

“There have been some physicians who’ve been in these facilities, but for the most part Customs and Border Patrol will not let us in there to see what‘s going on with these children,” she said.

Kraft said McAleenan called her for the first time on Dec. 26 and told her that with more and more children coming to the border, CBP is looking at what it can do to improve the situation.

“My message to him is that you really need to work with a pediatrician to look at these facilities to make sure that they’re right for children, and to make sure the medical care is adequate and that people are trained to recognize the subtle signs between a mildly ill child and a severely ill child,” she said.

The CBP follows its own National Standards on Transport, Escort, Detention, and Search, which call for officers and agents to ask detainees about medical concerns and to visually inspect for any signs of health issues. But the standards do not specifically call for pediatricians to be present in the facilities.

Homeland Security Secretary Kirstjen Nielsen said on Dec. 26 that she had asked U.S. Coast Guard medical personnel to assess CBP’s medical program and make recommendations for improvements.

Senate Judiciary Committee ranking member Dianne Feinstein has called for a hearing on CBP’s treatment of immigrant children, and incoming Chairman Lindsey Graham said Sunday on CNN’s State of the Union that he would convene hearings “on the deaths of these two children and the policies that entice people to come.”

The CBP standards urge against holding any detainees for more than 72 hours, but the director of Annunciation House, an El Paso group that helps provide housing for immigrants, said families have been held from five to 11 days.

Director Ruben Garcia spoke to a group of approximately 80 refugees at one of Annunciation House’s hospitality centers last week. “I wanted to get a sense of how long these families had been in holding cells, and I asked them, ‘How long were you detained?’” he said at a press briefing Dec. 27. “And as the hands went up, I started hearing, ‘I was in a holding cell for five days,’ ‘I was in a holding cell for seven days,’ ‘I was in a holding cell for nine, even up to 11 days.’”

Despite holding families for lengthy periods of time, CBP has argued that it’s not running detention facilities and therefore does not have to provide the same level of services, said Jennifer Podkul, the senior director for policy and advocacy at Kids in Need of Defense.

“Their position consistently with advocates has been, ‘We are not a detention center, so we’re not going to start offering all these things that a detention center will, like showers or beds with blankets or medical care.’ ... But the problem is, the reality is, they are. They’ve turned into a de facto detention facility when they’re holding these young families with children for long periods of time,” she said.

In CBP facilities, there may be a Border Patrol agent who has training as an emergency medical technician or in first aid, Podkul said, but she noted that detainees are likely not to see a medical professional until they’re handed over to Immigration and Customs Enforcement or the Office of Refugee Resettlement. “A child or even an adult might not even necessarily see anybody who has any sort of medical training before they’re transferred to a different place,” she said.

Podkul said that Border Patrol agents who conduct law enforcement operations are often tasked with ensuring the welfare of apprehended children. “We keep saying to them, 'It’s going to help you as much as it’s going to help the kids to hire somebody who has expertise in this,'” she said. “'Let somebody who is a professional in taking care of children take care of the children and then let your law enforcement agents conduct law enforcement action.' It shouldn’t be the same agents that are responsible for both because they’re obviously not able to do that.”

McAleenan in a statement on Monday said Border Patrol stations are not good facilities for families to stay long-term.

“129 children under the age of 5 have been referred for emergency medical care in the last week,” he said. “The care of those in CBP custody is paramount, and the United States Border Patrol is doing everything in its power to handle this crisis. The status quo is not acceptable. As Secretary Nielsen has stated, the system is at the breaking point. Border Patrol stations built decades ago are not resourced to handle this crisis and are not the best facilities to house children with their parents for extended periods.”

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