Originally Published by The Hill.
BY IRWIN REDLENER, OPINION CONTRIBUTOR — 01/08/19 0
THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL
With the deaths of two migrant children from Guatemala last month and another tear-gassing of crowds that included children just across the Southern U.S. border on New Year’s Day, nobody should argue against a thorough investigation of the circumstances that continue to place minors in highly dangerous situations. The fact that these “circumstances” are under the control of U.S. government agents justifies — even compels — us to make sure that protocols for managing an extraordinary immigration crisis do not endanger the lives of anyone, especially young children.
Furthermore, the red-hot partisan politics of immigration reform, including how we manage to appropriately secure our borders and keep out individuals who come with nefarious intent — yet, still allow for legal opportunities to seek opportunity or asylum in America will be one of the issues likely to be a high priority for the new Congress.
In fact, House Democrats have already announced that there will be oversight hearings examining how and why seven-year-old Jakelin Caal Maquin and 8-year-old Felipe Alonzo-Gomez lost their lives while under custody of U.S. Customs and Border Protection (CBP).
It is also worth noting that a thorough investigation of what happened to the children will reveal a great deal about how the policies and protocols of all agencies involved in border security function generally. Clearly, with more than 50,000 people coming across the U.S. Southern border some months, we are dealing with a system that is out of control and out of capacity to cope effectively. Still, we must fully understand and mitigate the conditions that endanger the lives of children for whom we have taken responsibility.
Here’s how I suggest the congressional oversight process be organized to get the most out of the upcoming hearings.
- Let’s be clear that agents of the federal government who take custody of children entering the U.S. have legal authority to do so.
But with that authority comes grave responsibility to make sure that such children are humanely sheltered, not be separated from primary caretakers, receive appropriate nutrition, and are expertly screened for possible health conditions requiring urgent medical attention. These principles should apply to any minor, whether they arrive with or without a family member, and irrespective of whether the crossing was legal or not.
Remember, too, that virtually every child that ends up in “the system” has come from terrible conditions in their home countries where they often lived in poverty with poor access to health care. They have endured substantial hardships making the arduous trek north. In essence, these young migrants are among the most vulnerable, at risk children on the planet.
Congressional investigators should review every aspect of the process that begins when agents first take custody of child, particularly how and why decisions are being made about detention assignments, why children are moved from one facility to another, and whether there are explicit guidelines assuring continuity of care for each individual child. For instance, are there case managers, social workers or formal guardian ad litem professionals assigned to all children who are in U.S. custody?
- The actual health screening of every child in detention facilities must be reviewed in detail.
Ultimately the health evaluation process must be comprehensive, formalized and mandated.
While there are some medical personnel available within Customs and Border Protection (CBP), there are far too few to fully staff all detention facilities to screen or treat sick children.
It should have happened a long time ago, but it is certainly encouraging that CBP Commissioner Kevin K. McAleenan finally reached out, albeit after Felipe’s death, to the highly reputed American Academy of Pediatrics (AAP), seeking advice as to how CBP or other agencies should screen for and manage possible serious medical conditions.
- Investigators should explore every aspect of the medical care Jacklin and Felipe ultimately received in community-based medical facilities outside federal control.
Many red flags have been raised for me. According to CBP, its agent told the medical staff at the receiving hospital that Felipe seemed to have a high fever and flu symptoms — suggesting a serious and sometimes fatal illness in children. But were appropriate tests performed? A throat swab did not reveal the presence of Strep infection, but there was no evidence that a nasal swab for Influenza infection was even taken.
4. Discharging a sick child from the emergency department with high fever on antibiotics which may not have been indicated warrants the attention of investigators. The idea that Felipe was discharged under the supervisory custody of a CBP agent would be extraordinarily risky — and would have been even if the child was returning to a normal home, no less a detention center.
Ultimately, the desired outcome of whatever investigations are launched by Congress or other agencies should go beyond assigning blame for the potentially avoidable losses of Jakelin and Felipe.
Rather, any investigation should conclude with recommendations for improving every aspect of the system. In other words, Congress must ensure that going forward, no more children under U.S. custody should needlessly perish because of dysfunctional, slipshod bureaucratic protocols or substandard medical care.
Irwin Redlener, M.D., is president emeritus and co-founder of the Children's Health Fund and has more than three decades of experience providing healthcare to medically underserved children. Redlener is also the director of the National Center for Disaster Preparedness at Columbia University’s Earth Institute, and professor of Health Policy and Management at the Mailman School of Public Health at Columbia University. Follow him on Twitter @IrwinRedlenerMD.