The detained immigrant told officials at the South Texas Detention Complex he’d been sexually assaulted and tortured in his home country and asked for medical care. Six weeks later, when he still hadn’t seen a doctor, the facility medical director offered this explanation: The complex didn’t have a local urologist on contract.

That wasn’t the only health care shortfall Immigration and Customs Enforcement (ICE) investigators cited in a 2008 report, one that didn’t name the detainee or his ethnicity. 

Sixteen of the facility’s 40 “critical” health care positions were vacant, leaving one staff doctor and two dozen nurses to care for nearly 1,400 detainees.  The complex had no psychiatrist and no dentist, and was short 11 nurses.  As a result, investigators said, chronic care management was “haphazard at best.” Monitoring of prescription drugs was lax. And not all intake screenings were performed on time.

“Poor medical care was the most problematic issue facing the facility,” investigators wrote. 

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ICE officials say the agency “is committed to providing all detainees in our care with timely, safe, humane and appropriate treatment.”

“Significant reforms are being made to the immigration detention system and health care management,” said agency spokesman Carl Rusnok.

But many federal authorities say they’re battling the same staffing shortages facing hospitals, nursing homes and prison systems nationwide. Though they are aggressively recruiting, they’re competing for candidates with the higher-paying private sector.

Immigrant rights groups say the remote locations of many Texas detention centers only contribute to high employee turnover and vacancy rates. That leads to overmedication, poorly kept medical records, and “sporadic and inconsistent care,” said Ann Baddour, a policy analyst with Texas Appleseed, a non-profit that uses volunteer lawyers to help solve social problems.

Some get no care at all, she said.

A 2007 review of medical care at the Willacy Detention Center in Raymondville found medical staffing was “barely adequate,” and that the facility’s clinic was too small to care for its 1,800 detainees. Twenty of the facility’s 46 health care positions were vacant. The detention center had no clinical director, dentist, pharmacist or psychiatrist. Half of Willacy’s licensed vocational nurses hadn’t even completed new employee orientation.

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In facility inspections in 2007 and 2008, investigators cited medical staffing shortages at the Port Isabel Service Processing Center, the El Paso Processing Center and the Laredo Contract Detention Facility.

In El Paso, five of the facility’s 34 health care positions were vacant – including the staff psychiatrist.

At the Port Isabel facility, inspectors found a third of detainees’ medical requests weren’t handled in a “timely” manner.

And in Laredo, inspectors found detainees with doctor-ordered dietary requirements weren’t getting the right food, and that patients had little privacy in the facility clinic. 

Kathleen Baldoni, a former nurse at the Willacy Detention Center, said these problems are common across Texas' facilities.

She said inmates suffering from health problems are "lucky to be seen within a week,” and that many illnesses occur because detainees don’t get enough water or nutritional food. Medical staff never even get around to simple quality of life fixes, she said, like cleaning out detainees’ hearing aids or replacing broken eye glasses.

“We didn’t delve into anything that wasn’t absolutely necessary,” said Baldoni, who has testified before Congress on health care in immigration detention. “After a while, you stop thinking about the people. You force yourself not to care as much. Because how else do you get the job done?”

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