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Have changes at Adelanto immigrant detention center led to better health care?

One morning in September at the Adelanto Detention Facility, a U.S. Immigration and Customs Enforcement agent walked the central corridor of the medical wing, pointing out the exam rooms and doctor’s offices to a group of visiting KPCC journalists.

The medical center looked shiny and clean under bright lights. It was completed just a couple of years ago by the contractor that operates the center, a private-prison company from Florida called The GEO Group.

“It’s some of what I think are state of the art facilities that a lot of others facilities don’t have,” said David Marin, a top ICE detention and removal agent.

Adelanto is one of many privately run immigrant detention centers around the United States. ICE contracts with the city of Adelanto for the space and the city, in turn, contracts with The Geo Group to run it. 

ICE has relied increasingly on private contractors to hold a detainee population that has exploded over the past two decades as immigration rules have tightened. ICE officials say they don’t have the capacity to handle so many detainees themselves.

In recent months, private facilities have drawn increasing attention, first from California state lawmakers, and more recently the federal Department of Homeland Security, which holds roughly 33,000 immigrants in detention on a daily basis.

There have been a series of problems over the years in ICE detention centers, including lawsuits tied to issues like overcrowding and medical negligence. And while problems haven't been limited to private detention centers, facilities like Adelanto have come under scrutiny.

The facility at Adelanto holds almost 1,900 immigrants.
Since 2012, three immigrants detained at Adelanto have died – two of them last year. Follow-up investigations have found problems that include delays in receiving care, poor record-keeping, and deficient communication among the medical staff.
In a federal review following one of the deaths last year, inspectors pointed out other issues: high turnover and relatively limited experience of the nursing staff, and a dearth of laboratory services that led to delays in treatment.
Earlier this year, ICE sought improvements.
“I don’t think it was one death in particular,” ICE’s Marin said. “I think it was sort of we stopped, and took a look at everything, and said, 'Hey, what can we do to improve our medical services here?'”
In response to ICE concerns, GEO Group made a change: in February, the company stopped providing its own medical care at Adelanto and handed it to a subcontractor, Correct Care Solutions.
GEO Group officials said Correct Care Solutions is not a subsidiary. But Correct Care Solutions services numerous GEO Group contracts. Its CEO Jorge Dominicis is a former executive with GEO Group, who joined Correct Care Solutions in 2014 when the company bought one of GEO Group’s mental health divisions. He remained on the GEO Group's payroll as a consultant, according to federal Securities and Exchange Commission records.

When the switch to Correct Care Solutions took place this year, many of the same GEO medical staffers stayed on.

“Many of the preexisting employees in the medical area were retained...,” GEO Group spokesman Pablo Paez confirmed in an email.

Los Angeles immigration lawyer Veronica Barba said she found this troubling. 

“There is no improvement in the system if we are just going to keep calling it a different name, but keep the same system in place, and the same people, and the same players in that system,” Barba said.

ICE officials know about the relationship between GEO Group and Correct Care Solutions.

ICE’s Dave Marin said the agency didn’t ask GEO Group for a new medical subcontractor. Officials just wanted better outcomes for sick detainees, especially those who arrive at the detention already sick, he said.

 “We didn’t tell them how to do it, or to contract with somebody else or do something,” Marin said. “But we asked them to look at some things, one being the chronic care issue.”
ICE, GEO Group, and Correct Care Solutions all said they are working together to address ongoing issues.
ICE officials said they’ve sped up the time it takes to get medical care. The agency said it has also streamlined the medical request procedures, making it easier for detainees to seek treatment.

Change for the better?

Whether all this has made a difference in medical care depends on who you ask. Different detainees who have received medical treatment at Adelanto in recent months report different experiences.

Alireza Dahkteh has been at Adelanto since November. He's fighting deportation to his native Iran after serving time for a drug offense. Dahkteh said around January, he got sick. He had chronic hiccups and was worried he might have pneumonia, which he has had before.

After a few days, Dakhteh sought treatment. He put in a request for treatment by submitting a form, referred to as a “Kite.”

“I had to ask for medical to see me, and they said you have to file a Kite,” Dakhteh said. “I filed a Kite. After five days, I had to make a complaint.”

After that, he said, a nurse came to see him. Dakhtek said the entire process took about a week. He doesn’t think that much has changed since Correct Care Solutions, the new medical subcontractor, took over.

“All I see is that now you fill out a different form to see a doctor,” Dakhteh said. “I don’t see many other things change.”

Recently, he said, he saw a man with an injured ankle make a scene to get medical attention.

“He kept complaining, ‘I need someone to look at my ankle,’ and nobody cared. Then all of a sudden in the chow hall, the place where we eat, he made a show, basically,” Dahkteh said.

Dahkteh said the man lay down on the floor "and started complaining, ‘Oh my foot, oh my foot’ — and people showed up.” 

But Xochitl Hernandez, on the other hand, said she saw some improvement while there. Hernandez, an unauthorized immigrant from Mexico, arrived in Adelanto last February as the switch in medical care providers took place.

Her first experience was a bad one, she said. Soon after she arrived, she developed a urinary tract infection. She said it took several days of complaining before she received treatment.

“It took them a long time to see me,” Hernandez said, in Spanish. “I would tell them that my stomach hurt, until one day it started hurting a lot, about midnight, and they came and got me."

Hernandez was given antibiotics and recovered. Then about three months ago, she slipped on soap and fell near the showers. She had to get X-rays for her arm and shoulder.

She said it still hurts, but at least she got in to see a doctor quicker — in about two days.
“Just before I left, things started getting better,” Hernandez said. “I think they are making changes. Because there are more nurses, and they attend to you better.”

She said there’s one change she’d like to see – more staffers who can communicate with immigrant detainees in their own language. Hernandez, who speaks Spanish, said many staffers speak only English.

Jim Cheney, a spokesman for Correct Care Solutions, said in an email that the staff is “equipped to deal with patients who do not speak English as their first language.” But he would not say how many staffers speak Spanish.
Cheney said the National Commission on Correctional Healthcare, a nonprofit offering a voluntary accreditation program, accredited Adelanto's health center in March.

As for Barba, the immigration lawyer, she said after the switch in medical providers, she began getting her clients' medical records back sooner. But now, when she has questions about their care, the added layer of contracting makes it harder to get answers.

“If I call ICE, they say they don’t oversee the contractor, and the same with GEO,” Barba said. “They say it’s a contractor they don’t control.”

ICE officials acknowledge there’s room for improvement in providing medical care to the detainees. The Adelanto center has a staff of more than 500 and only about 50 are government employees. The rest work for GEO Group, Correct Care Solutions, or Spectrum, a private firm that provides detention offices under contract to supplement ICE's staff.

ICE officials also point to the oversight that they are under: federal inspectors visit Adeltano at least once a year. And they add there is ICE medical staff on site that can help supervise the care that Correct Care Solutions provides.

But ICE officials also acknowledge the supervision can only go so far — there’s only one ICE medical officer at Adelanto.