The death of a toddler is renewing concerns about the quality of medical care that immigrant families receive in federal detention centers.
Eighteen-month-old Mariee Juárez died after being detained along with her mother Yazmin Juárez at the South Texas Family Residential Center in Dilley, Texas. Her mother says Mariee was a happy, healthy child when they arrived at the U.S. border in March to seek asylum.
Then they were sent to Dilley. Six weeks after being discharged, her mother says, Mariee died of a treatable respiratory infection that began during her detention.
"The conditions at Dilley were unsanitary, unsafe and inappropriate for any small child," said R. Stanton Jones, a lawyer at the firm Arnold & Porter, which is representing Yazmin Juárez.
When Juárez raised concerns about her daughter's deteriorating condition, he alleges, she wasn't taken seriously. "The medical care that Mariee received in Dilley was neglectful and substandard," Jones said.
Doctors and immigrant advocates have long complained about the medical care at family detention centers overseen by U.S. Immigration and Customs Enforcement, or ICE. Dilley is the largest of three such facilities, with 2,400 beds.
Those concerns have taken on new urgency as the Trump administration looks to detain more migrant families. In June, ICE requested space to accommodate 15,000 additional beds.
ICE declined to comment on the details of Mariee's case, which was first reported by VICE News. But the agency says it takes the welfare of immigrants in its care seriously.
"ICE is committed to ensuring the welfare of all those in the agency's custody, including providing access to necessary and appropriate medical care," ICE said in an emailed statement. "Staffing includes registered nurses and licensed practical nurses, licensed mental health providers, mid-level providers that include a physician's assistant and nurse practitioner, a physician, dental care, and access to 24-hour emergency care."
But a pediatrician who reviewed Mariee's medical records says she did not receive adequate care in Dilley.
"Nobody at any time decided to actually have a pediatrician or a doctor see the child," said Benard Dreyer, the director of pediatrics at the Bellevue Hospital Center in New York, and a past president of the American Academy of Pediatrics.
Dreyer reviewed Mariee's medical records from her time at Dilley at the request of her mother's lawyers, and says that nurses and physician assistants overlooked several high fevers, and other signs that Mariee's respiratory infection was getting worse.
"Can we guarantee that if [she] had been sent to the hospital a week earlier, it wouldn't have been too late? I can't guarantee that," Dreyer said. But he adds, "the child was very sick and should have been sent to a hospital."
Instead, Yazmin Juárez's lawyers say, Mariee was simply discharged from Dilley without ever seeing a doctor. Juárez and her daughter were driven to the airport in San Antonio. They flew to New Jersey, where Juárez took Mariee to the emergency room.
Mariee spent the last weeks of her life in hospitals. She died on May 10 of respiratory failure.
Her mother's lawyers signaled on Tuesday that they intend to sue. They're seeking seeking $40 million in damages for Mariee's "wrongful death" from the city of Eloy, Ariz. (Eloy is official contractor for Dilley under an unusual arrangement with the Department of Homeland Security and CoreCivic, the private prison company that operates the facility).
More lawsuits are expected to follow.
Doctors and immigrant rights advocates who are familiar with medical care in Dilley and other family detention centers say they're not surprised by Mariee's death.
In July, two doctors contracted by the Department of Homeland Security released a scathing assessment of care at those facilities. Scott Allen and Pamela McPherson conducted 10 investigations of family detention centers over the past four years, and found widespread problems with inadequate staffing and poor training.
"The threats to health and safety of the children are not merely theoretical," Allen and McPherson wrote. Family detention is "an exploitation and an assault on the dignity and health of children and families."
RACHEL MARTIN, HOST:
The Trump administration has ended the official policy of separating migrant families and housing children apart from their detained parents. Now the administration says it wants to detain more migrant families together rather than releasing them to await immigration court hearings. Doctors warn, however, that children face significant risk of harm while they're in detention. NPR's Joel Rose has the story of one toddler who died after being held at a family detention center in Texas.
JOEL ROSE, BYLINE: Yazmin Juarez and her daughter Mariee were among thousands of families fleeing violence and turmoil in Central America to seek asylum in the U.S. They crossed the Rio Grande illegally into Texas in March.
STANTON JONES: Mariee was a completely normal, healthy, happy 18-month-old little girl when they arrived in the United States.
ROSE: Stanton Jones is a lawyer with Arnold & Porter, the firm that's representing Mariee's mother. He says the little girl and her mother were placed in the custody of U.S. Immigration and Customs Enforcement, or ICE, and taken to the South Texas Family Residential Center in Dilley. It's the largest family detention center in the country with 2,400 beds for mothers and their children. Within a week, Jones says, Mariee got sick.
JONES: Starting with congestion, cough, runny nose - but then quickly, her condition deteriorated, and she had a fever over 104 degrees.
ROSE: Juarez tried to get help from the medical staff in Dilley, but Jones says they didn't take her seriously. And Mariee's respiratory infection got worse. Bernard Dreyer is the head of pediatrics at Bellevue Hospital in New York and past president of the American Academy of Pediatrics. He reviewed Mariee's medical records from Dilley at the request of her mother's lawyers.
BERNARD DREYER: When a child has fevers and respiratory symptoms for, you know, weeks, they should be sent in to an emergency room, and that was never done.
ROSE: According to medical records, Mariee was supposed to see a doctor in Dilley, but that never happened. Immigration authorities determined that the family's asylum claim could move forward and released them. They flew to New Jersey to stay with relatives. Juarez took Mariee to the emergency room the next day. Mariee spent the next six weeks in hospitals before she died of respiratory failure. Dreyer says her condition is treatable if it's caught early.
DREYER: Can we guarantee that if this kid had been sent to a hospital a week earlier it wouldn't have been too late? I can't guarantee that, but very few kids die from pneumonia.
ROSE: Lawyers for Yazmin Juarez initiated legal action on Tuesday when they said they planned to file a wrongful death lawsuit seeking millions in damages. ICE declined comment on the details of Mariee's case. But in a statement, the agency says it's committed to ensuring the welfare of everyone in its custody. On Capitol Hill last month, a top ICE official, Matthew Albence, defended the care at these detention centers.
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MATTHEW ALBENCE: They have extensive medical, dental and mental health opportunities, so I'm very comfortable with the level of service and protection that is being provided.
ROSE: But two doctors contracted by the Department of Homeland Security, which includes ICE, were alarmed by the pediatric care they found. In a scathing report last month, they said dangerous symptoms, like weight loss, were ignored, while some children were given adult doses of vaccines. Katie Shepherd is a former managing attorney of the Dilley Pro Bono Project, which represents women detained there.
KATHRYN SHEPHERD: I realize how horrific this sounds, but I am surprised that a child or a mother has not died within the walls of the detention center in Dilley.
ROSE: Shepherd and other immigrant rights activists have complained for years about conditions in Dilley. They are deeply alarmed that the Trump administration is seeking to build family detention space for another 15,000 people.
Joel Rose, NPR News.
(SOUNDBITE OF THE BURNING PARIS' "THE SUN ALSO RISES") Transcript provided by NPR, Copyright NPR.