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Continuity of TB Therapy for U.S. Immigration

and Customs Enforcement (ICE) Detainees

An Update

Advisory Council for the Elimination of Tuberculosis

March 20, 2007

Diana Schneider, DrPH, MACDR, US Public Health Service

U.S. Department of Health and Human ServicesHealth Resources and Services Administration

Bureau of Primary Health CareDivision of Immigration Health Services

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ICE Custody

• ICE detention is to facilitate removal

• Criminal charges resolved before admission to ICE custody

• ICE must remove individual as soon as possible following Final Order of Removal

• Must remove within 90 days by statute

• Post Order Custody Review if removal cannot be accomplished within 180 days

• If otherwise can be deported, cannot keep people in custody because of illness

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Service Processing Centers and Contract Detention Service Processing Centers and Contract Detention Facilities that House U.S. Immigration and Customs Facilities that House U.S. Immigration and Customs

Enforcement (ICE) Detainees*Enforcement (ICE) Detainees*

ICE Service Processing Center and ICE Staging Facility, DIHS staffing,digital radiography screening

ICE Service Processing Center, DIHS staffing, TST screening Contract Detention Facility or IGSA, DIHS staffing, digital radiography

screening Contract Detention Facility or IGSA, DIHS staffing, TST screening Contract Detention Facility or IGSA, Contractor staffing, TST screening* Locations without symbols have ICE detainees housed in local jails

nationwide

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TB among ICE Detainees

• Intake Medical Screening/TB Screening– Infection control– Maintain a safe detention and working

environment– Case detection– Continue or initiate treatment as indicated

• Detainees with active TB often deported prior to completion of treatment

• ICE does not deport patients while contagious

• Patients often deported before culture results are available

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U.S. Immigration and Customs Enforcement Detainees Active Tuberculosis Cases Reported to Immigration Health Services, by Country and Release

Status*, 2005

0

10

20

30

40

50

60

70

BRAZIL

CHINA

CUBA

ECUADOR

EL SALV

ADOR

ERITREA

GUATEM

ALAHAIT

I

HONDURAS

MEXIC

O

NICARAGUA

PERU

SUDAN

VIETNAM

Country

Co

un

t missing

RELEASED IN U.S.

REMOVED

*Classified as a TB case by treating physician; not verified as meeting CDC criteria for national surveillance

Release Status

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TB Continuity of Care Processes

• Notification to DIHS Epidemiology Unit

• Short-term medical holds

• Referral for treatment and case management– TBNet Program

– CureTB Program

• Binational TB Card

• Coordinated Removal / Medical “meet and greet”

• Requests for stays of removal

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Stays of Removal

• Stays of removal may be considered

– MDR, medically complicated, nonadherence, concomitant mental health conditions, frequent border crossers

– Do not ensure continued custody

– ICE may require other secure environment• (U.S.) State and local jurisdictions have

authority to compel isolation and treatment

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Challenges

• Notification before release

• Differing diagnostic and treatment norms U.S. vs. other

• Adherence

• Authorities to compel isolation and treatment are unclear

• Information-sharing across jurisdictional boundaries

• If stays of removal are granted, case management may become health department responsibility

• Department of Homeland Security initiatives– Secure Border Initiative– Increasing detention capacity– Expedited removals

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Workgroup Recommendations (1)

1. Engage the foreign national health authorities and the U.S.-Mexico Border Health Commission to:

a. Establish mechanisms to foster binational and international collaborations regarding TB case management, including • electronic information sharing/health record• sharing of expertise and resources• treatment, medication availability• laboratory support• adherence• contact investigations

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Workgroup Recommendations (2)

b. Convene a public health legal forum to better facilitate binational/international case management

c. Engage the foreign National TB Programs to promote collaboration with coordinated removals / TB meet and greets

2. Recommend to CDC that a mechanism be established to count all TB cases that are managed by state and local TB control programs for determining federal funding

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Next Steps

• Evaluation initiated– Assess outcomes– Stakeholder interviews

• Continue education and outreach– State and regional TB meetings– NTCA breakout session– Planning webinar with Southeast

Regional TB Training and Medical Consultation Center

– Educational materials• Workgroup conference calls

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AcknowledgementsDIHS Staff:Aguadilla, PR: CDR Karen Dorse, CDR Wanda Gonzalez Batavia, NY: CDR Jeri McGinnis, LT Deborah Doody, Dr. Brenda Bailey El Centro, CA:, LCDR Eileen Falzini, LCDR Upeng Demske, Dr. Carlos DuchesneEl Paso, TX : LCDR Erik Hierholzer, LCDR Zita Guerrero, Dr. Rosa Colon, LCDR Chiara

RodriguezElizabeth, NJ:, LCDR Rusty Waldron, LT Jonee Mearns, LT Raymond de la Peña, Dr.

Chang ParkEloy, AZ: LCDR Melissa GeorgeFlorence, AZ: CDR Claire Karlson, Dr. Elizabeth Fleming, LT Marc WinokerHarlingen, TX: LCDR William RekwardHouston, TX: CAPT Christine Williams, LT, Monique Frazier, LT Cynthia Beard Los Angeles, CA: LCDR Jason Ortiz, LTJG Katherine MayeMiami, FL: CDR Kirsten Warwar, CDR Jaime Muñiz, Dr. Abelardo Montalvo, LCDR

Andrew GanzonPearsall, TX: CAPT BuJean Jenkins, Dr. Erik Johnson, LCDR Gina ChaconPort Isabel, TX: CAPT Marian Moe, LT Maria Morel, CDR Adolfo Zorilla, Dr. Luz

Peredo-BergerSan Diego, CA: LCDR Steve Gonsalves, Dr. Ester Hui, LCDR Bonnie SaylorSan Pedro, CA: LCDR Chris Henneford, LT Shelly HollandsworthStewart, GA: CDR Lynn Harris, CDR Sherlene Jacques, CDR Betty ShawTacoma, WA: LCDR Deanna Gephart, LT Christine Chang, Dr. Phil FarabaughTaylor, TX: LCDR Tom Hochberg, CDR Peggy Mathis, LCDR Angel LaSantaWillacy, TX: CDR Dawn Anderson-GaryHeadquarters: Mr. Neil Sampson, Dr. Tim Shack, LCDR Alice Fike, Ms. Jennifer

Cheng

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Acknowledgements• ICE/DHS: Jay Brooks; Joan Lieberman; Tim Perry, Nina Dozoretz• CDC: Ken Castro, Mark Lobato, Kayla Laserson, Stephen Waterman, Maureen

Wilce, Miguel Escobedo, Steve Harris, Todd Wilson, Steve Benoit, Bill MacKenzie• DHHS/OGC: Jocelyn Mendelsohn• Arizona Dept. of Health Services: Karen Lewis, Angelito Bravo, Patty Gast,

Ayesha Bashir• Arizona Attorney General’s Office: Kevin Ray, Don Schmidt• CA Dept. of Health Services: Sarah Royce, Anne Cass, Stephanie Spencer• Colorado Department of Health: Barb Stone, Gayle Schack• Denver TB Control: Randall Reves• Florida Dept. of Health: Halsey Rhodes, Toni Johns• Georgia Department of Human Resources: Beverly Devoe-Payton, Karen Buford• New Mexico: Gary Simpson, Cliff Rees• TX Dept. of State Health Services: Charles Wallace, Phyllis Cruise, Sandra

Morris, Mike Greenburg, Walter Erhesman, Jose Moreira, Maria Rodriguez • San Diego County Health Dept/CureTB: Kathy Moser, Alberto Colorado,

Florencia Sisterson, Francisco Velasco, Rafael Garcia• Migrant Clinicians Network: Jeanne Laswell, Del Garcia, Ed Zuroweste, Bertha

Armendariz, Nora Martinez, Karen Mountain• Public Health Institute (CA): Samantha Graff• Pan American Health Organization: Kam Suan Mung, Guillermo Mendoza, Mirtha

del Granado• U.S.-Mexico Border Health Commission: Dan Reyna• National TB Programs: El Salvador, Guatemala, Honduras, Nicaragua

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Contacts and Information

• Division of Immigration Health Services Diana Schneider, DrPH, MAphone: (202) 732-0070e-mail: Diana.Schneider@dhs.gov

• www.ice.gov

• www.dhs.gov/immigrationstatistics

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Objectives

• Provide background on the DIHS/ICE TB Continuity of Care Program

• Provide an update on TB continuity of care activities for U.S. Immigration and Customs Enforcement detainees

• Present workgroup recommendations

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ICE Custody

Border apprehensions

Special MissionsInterior Apprehensions

Transfer from other law

enforcement entities

Often poor or no documentation of previously diagnosed medical conditions

Intake Screening

includes TB screening

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41

58

7277

142

0

20

40

60

80

100

120

140

160

CY2001 CY2002 CY2003 CY2004 CY2005

Reported Active TB

Year

Co

un

t

U.S. Immigration and Customs Enforcement DetaineesActive Tuberculosis Cases Reported to the Division of Immigration Health Services*, 2001-2005

*Classified as a TB case by treating physician; not verified as meeting CDC criteria for national surveillance