Three children died in U.S. Customs and Border Protection’s custody in fiscal year 2019, prompting questions about medical care in the agency’s southwest border facilities.
CBP developed health screening policies and received emergency funds to enhance detainees’ medical care. But CBP hasn’t consistently overseen these policies, so some children were not given health screenings as intended. Further, CBP violated appropriations law by using some of these funds for items such as its canine program. CBP also lacks reliable data on deaths and didn’t report this data to Congress as directed.
We testified on ways to address these issues.
Medical Provider Office at a U.S. Customs and Border Protection Facility
What GAO Found
As of May 2020, U.S. Customs and Border Protection (CBP) within the Department of Homeland Security (DHS) had obligated nearly $87 million of the approximately $112 million it received specifically for consumables and medical care in a 2019 emergency supplemental appropriations act (2019 Emergency Supplemental). CBP obligated some of these funds for consumable goods and services, like food and hygiene products, as well as medical care goods and services, such as defibrillators, masks, and gloves. However, CBP obligated some of these funds for other purposes in violation of appropriations law. For example, CBP obligated some of these funds for
- goods and services for its canine program;
- equipment for facility operations like printers and speakers;
- transportation items that did not have a primary purpose of medical care; and
- upgrades to computer networks used for border enforcement activities.
GAO identified two factors that contributed to CBP's appropriation law violations—insufficient guidance to CBP offices and components before obligations were made, and a lack of oversight roles and responsibilities for reviewing obligations once made. After the 2019 Emergency Supplemental was enacted, CBP did not provide sufficient guidance explaining how offices and components could obligate funds for consumables and medical care and, as a result, some offices and components may not have understood that there were limitations on how they could use those funds. For example, officials from one CBP component stated they believed they could use the consumables and medical care funds for any goods or services they considered to be in the interest of individuals in custody or that would help ensure the efficient processing of individuals. Additionally, while CBP offices and components took some steps to oversee obligations from the 2019 Emergency Supplemental funds, GAO identified gaps in CBP's roles and responsibilities for reviewing obligations to ensure they were consistent with the intended purpose of the funds.
CBP took various steps to enhance medical care and services for individuals in its custody, including, among other things, increasing its use of contracted medical providers, issuing new health screening policies, and requesting the Centers for Disease Control and Prevention to assess conditions and make recommendations for the reduction of influenza in its facilities. In particular, in January 2019 CBP issued an interim directive which, among other things, required health interviews and medical assessments for certain individuals in its custody. CBP updated this directive in December 2019 and issued corresponding implementation plans in March 2020.
GAO also identified gaps related to CBP's implementation and oversight of its medical care efforts. For example:
- CBP had not consistently implemented enhanced medical care policies and procedures at southwest border facilities. Through facility visits and analysis of data, GAO found that some locations were not consistently conducting health interviews and medical assessments, as required by the medical directives; and
- CBP decided not to implement a recommendation from the Centers for Disease Control and Prevention to offer influenza vaccines to individuals in custody but did not document how it had arrived at this decision. CBP documentation stated that vaccinating apprehended individuals would pose operational, medical, legal, and logistical challenges. CBP officials stated that they made this decision in consultation with others in the Department of Homeland Security and that this group continues to meet on public health issues and will use such meetings to reassess whether to offer influenza vaccines.
Finally, from fiscal year 2015 through fiscal year 2019, CBP was directed to report on deaths of individuals in its custody to Congress. Additionally, in fiscal year 2014, DHS was directed to provide information on deaths in custody in summary statistics to Congress. GAO’s review of CBP documentation and reports to Congress showed that 31 individuals died in custody along the southwest border from fiscal years 2014 through 2019, but CBP documented 20 deaths in its reports.
Why GAO Did This Study
Three children died in CBP custody between December 2018 and May 2019, prompting questions about CBP's medical care for those in its custody. In July 2019, an emergency supplemental appropriations act was enacted, providing additional funds to CBP, including funds for consumables and medical care.
This testimony summarizes key information contained in GAO's July 2020 report, entitled Southwest Border: CBP Needs to Increase Oversight of Funds, Medical Care, and Reporting of Deaths (GAO-20-536).
In the report upon which this testimony is based, GAO made 10 recommendations to CBP, including providing additional guidance and oversight of appropriated funds; developing and implementing oversight mechanisms related to medical care policies; documenting decisions made regarding offering the influenza vaccine; and providing guidance to ensure that deaths in custody are reported to Congress, as directed. DHS concurred with all 10 recommendations.