The report is the latest in a string of findings describing inadequate detention conditions in 2019, when a surge of migrants at the US-Mexico border overwhelmed government facilities and eventually resulted in Congress appropriating additional funds. GAO said its review was prompted in part by questions about CBP's medical care after three children died in custody between December 2018 and May 2019.
While CBP took steps to improve medical care in custody, the agency "has not consistently implemented enhanced medical care policies and procedures," according to the report. For example, during visits to CBP facilities in November 2019 in south Texas, the GAO found that while some facilities were conducting health interviews and medical assessments, others were not.
CBP also decided not to offer influenza vaccines despite a recommendation from the Centers for Disease Control and Prevention, but didn't document how it came to the decision, the GAO said.
In a statement to CNN, CBP said it "takes its role in providing care and ensuring the health, safety, security, and welfare of each adult and child in its custody very seriously," adding that the agency "is committed to improving its care and custody of adults and children and requested emergency supplemental funds to support these operations along the southwest border in order to do so."
The report describes a lack of oversight and insufficient reporting mechanisms to track deaths in custody. "CBP does not have reliable information on deaths, serious injuries, and suicide attempts and has not consistently reported deaths of individuals in custody to Congress," the report states. GAO's review found 31 individuals died in custody along the southern border between fiscal years 2014 through 2019, but CBP documented only 20 deaths in reports.
The government watchdog also included details on the misuse of funds intended for medical care, following up a report released by the office last month with similar findings.
The supplemental funds provided to the Trump administration amid the crisis at the southern border included approximately $112 million for "consumables and medical care." As of May, 78% of those funds have been obligated, according to the GAO report. To that end, the government watchdog found that CBP violated appropriations law when it used some of the funds for purposes other than originally intended, like upgrades to computer networks.
Among the factors that contributed to those violations, the GAO said, was insufficient guidance to CBP offices and components about how the money was to be used as well as lack of oversight.
CBP defended its spending in its statement, saying that "only a very small percentage of these obligations were inaccurately categorized."
This story has been updated with a statement from US Customs and Border Protection.