From the U.S. Government Accountability Office, www.gao.gov Transcript for: Medical Care for Immigration Detainees Description: Audio interview by GAO staff with Rebecca Gambler, Director, Homeland Security and Justice Related GAO Work: GAO-16-231: Immigration Detention: Additional Actions Needed to Strengthen Management and Oversight of Detainee Medical Care Released: February 2016 [ Background Music ] [ Narrator: ] Welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. It's February 2016. U.S. Immigration and Customs Enforcement, a DHS agency, is responsible for providing safe, secure, and humane confinement for individuals who are held in immigration detention facilities. A team led by Rebecca Gambler, a director in GAO's Homeland Security and Justice team, recently reviewed medical care for immigration detainees. GAO's Jacques Arsenault sat down with Rebecca to talk about what they found. [ Jacques Arsenault: ] For starters, can you tell me about how many people are held in immigration detention facilities? [ Rebecca Gambler: ] In fiscal year 2015 on any given day, there were about 32,000 individuals housed in immigration detention facilities. [ Jacques Arsenault: ] And what's happening to these people while they're in the facilities? [ Rebecca Gambler: ] Individuals who are housed in detention facilities are in civil or administrative detention and so they're really waiting to have their case heard before immigration courts or they may have been ordered removed from the country and they're waiting for that removal to take place. [ Jacques Arsenault: ] So they're sort of waiting for one part of the process or another. [ Rebecca Gambler: ] They're waiting for some action related to their immigration status or immigration case in the U.S. [ Jacques Arsenault: ] And when people are in these facilities, they're really the responsibility of the federal government and that includes the responsibility for medical care. Can you talk about what the federal government's responsibility is in that case? [ Rebecca Gambler: ] Sure. Immigration and Customs Enforcement or ICE has responsibility for overseeing and actually providing medical care to individuals in detention facilities and that includes providing care through clinics that are onsite at detention facilities as well as overseeing requests for and approvals of requests for offsite medical care. Examples of offsite medical care would include things like emergency services or treatment for longer term or chronic conditions. [ Jacques Arsenault: ] Okay, so ICE could be providing the care themselves or they could be contracting it out or sending folks out to existing health clinics and then paying for that after the fact. [ Rebecca Gambler: ] That's right. And at some facilities as it relates to onsite care, ICE medical corps staff actually provide the care directly to individuals in those facilities and at other facilities, ICE contracts onsite medical care with local government agencies or sometimes with private contractors. [ Jacques Arsenault: ] Okay. So in this report, your team was really trying to get more of a sense of the care that's actually provided and it seems like you ran into some challenges with finding data or getting the full picture. Can you tell me about that? [ Rebecca Gambler: ] I can, specifically as it relates to offsite medical care. We found two primary issues with ICE's oversight. First, ICE has data on requests and approvals and denials for offsite medical care but we found that that information can be sorted or searched in such a way to identify trends across procedure types or across facility types. And that really limits ICE's oversight relating to the consistency with which decisions are made for approving offsite medical care. Secondly, we found that ICE was not really able to affectively link approvals for offsite medical care to amounts paid out for that care. And that was an issue again in terms of ICE having the information it needs to affectively oversee the provision of care. [ Jacques Arsenault: ] So it sounds almost, in the first case, like they don't have the data that they need to be affectively planning for the future and in the second case, there's some potential accounting problems. You know they know what they requested and they know what they paid but they can't necessarily make those two line up. [ Rebecca Gambler: ] That's right. And during the time period that we studied for our report, we found that there were differences across fiscal years in terms of requests for medical care approved and the amounts that were actually paid out. [ Jacques Arsenault: ] Okay. Now you also looked at complaints and what the process is for handling complaints. Can you talk about what you found or what you didn't find there? [ Rebecca Gambler: ] Sure. As it relates to complaints, individuals in detention facilities have a number of different avenues that they can pursue to make medical care complaints. They can make complaints directly to the facilities or they can lodge complaints with different components in agencies within ICE and the Department of Homeland Security. And while having those multiple avenues is really positive, what we found is that ICE really didn't have data that paints a complete picture of the types of medical complaints that are received by the different entities. [ Jacques Arsenault: ] So again, it's harder for them to find where those big problems are and where they should be focusing their efforts. [ Rebecca Gambler: ] That's right. It's difficult for them to really be able to assess trends across the types of complaints they receive and have the information they need to make sure that they are effectively addressing those complaints. [ Jacques Arsenault: ] So then let me ask you, how do you fix this? What are the recommendations that you're making to ICE in this report? [ Rebecca Gambler: ] We made a number of recommendations related to helping ICE improve the information and data that they have for overseeing the provision of medical care. So we recommended that they develop mechanisms to better assess trends and procedures requested and approved by both procedure type and facility type. We also recommended that they better link approvals for medical care to amounts paid and we recommended that they collect and maintain more complete data on the universe of medical complaints that are received. [ Jacques Arsenault: ] And finally, what would you say is the bottom line of this report? [ Rebecca Gambler: ] The bottom line is really that ICE has policies and processes in place to provide medical care to individuals housed in detention facilities. However, ICE needs more complete data and more reliable data to be able to effectively oversee the provision of that care. [ Background Music ] [ Narrator: ] To learn more, visit GAO.gov and be sure to tune in to the next episode of GAO's Watchdog Report for more from the congressional watchdog, the U.S. Government Accountability Office.