Table 5 Clinicians’ recollection of Select Cases Involving Individuals recently released from immigration detention

Cases involving Pregnant people

“Patient with pyelonephritis that went untreated while in detention center, was released only when she went into unstoppable preterm labor due to her infection”.

“Patient was told by medical providers at the detention center that she was not pregnant, and thus was not provided with any prenatal care. Was released when she reached full term gestation, and ended up giving birth with her IUD still in place because no one at the detention facility would remove it for her”.

“The one I constantly think about is a woman who was pregnant and kept complaining of stomach pain. She was told it was reflux and given tums. She complained several times and finally, a week after the pain started, was brought to the hospital. She was found to have an ectopic pregnancy- a pregnancy outside of the uterus, in one of her fallopian tubes. We took her back to the OR emergently and took out the ectopic pregnancy, but her entire belly was full of blood. She had clearly been bleeding for a while.”

“A case of a young lady who was pregnant in the third trimester. Brought into the emergency department due to headaches, elevated blood pressures. Found to have severe range blood pressures along with other markers of pre-eclampsia with severe features and an intrauterine fetal demise”.

“We had a third-trimester pregnant patient who was clearly visibly pregnant (and reported that she had advised authorities of her pregnant status) who had no basic health intake or blood pressure check, and despite complaining to authorities that she didn’t feel well she wasn’t taken for medical attention until she had an eclamptic seizure. She was critically ill from the time she was transported from the original hospital she was taken to (unequipped to handle the level of care she needed). She didn’t follow up as needed due to fear she would be taken back to the detention center.”

Pediatric cases

A child in family detention for 4 months who demonstrated malnutrition based on weight for stature in first percentile, and weight loss over the first 2 months of his detention. He was given inadequate diet and medical care during this period.

Child with juvenile dermatomyositis whose prescription medications were confiscated and whose condition deteriorated because of lack of access to medications upon arrival in our community.

Child with seizure disorder whose medications were confiscated and who was ultimately hospitalized.

A 10 yr old with asthma, meds taken away while in detention and not returned, had asthma exacerbation after release and mother had no meds.

Teenage boy with refractory epilepsy that was ultimately deemed surgically resectable (2 years after his arrival), who upon arrival had limited supply of Vimpat and was not provided with a bridge supply or adequate substitute while in detention. His second medicine, Keppra, was available.

Teenager held in ORR shelter × 1 year, misdiagnosed bipolar, sedated on meds × 6 months and had PTSD, seen by psychiatry at discharge and taken off of these meds

Child unnecessarily kept in detention despite the fact that his mother was available because staff reasoned she could not take care of his behavioral needs (including a form of selective mutism). Through my evaluation and interview with mother, I realized the minor was not cognitively impaired but traumatized.

Child with undiagnosed congenital heart disease who came to clinic with dyspnea and oxygen saturation in the 70’s

A minor who acquired an ankle fracture and was not treated for days.

Infant with concern for dehydration separated from minor breastfeeding mom and given to adult dad. Neonate with fever and cyanosis. Dehydration from gastroenteritis. Severe respiratory infections and respiratory distress.

Mental health poorly addressed

I followed one schizophrenic male who was decompensating and put into solitary and treated with vistaril and antidepressants. It took close to a year to get him on an antipsychotic.

Out of control dm II, depression with psychosis sent out with no housing, ptsd not diagnosed

The staff were insensitive, took clothing away from the transgender woman which was particularly hurtful.

Other serious health issues

Case of patient placed on incorrect HIV regimen for months and experienced worsening resistance profile (which was already very severe) further limiting treatment options. HIV virus level never reached undetectable, but appropriate resistance testing never performed and regimen never changed.

Patients with post-concussive syndrome getting no imaging or treatment with significant morbidity.

COVID-19 related Care

Young woman with COVID, tachy to 160 s documented, reported CP/SOB/palpitations. Detention center did not get any imaging, ECG, or labs (except for a routine thyroid study) and had no consideration of PE/MI/arrhythmia/etc. They sent her back to her cell with no vitals for 13 h and told her to “drink more water”.

A 3 yo experienced constipation and poor weight gain as a result of inappropriate diet during a 3 month detention. He also got influenza and fractured a finger in a metal door at the facility. He was on COVID quarantine (22 h in a small room with his mother and brother) for 14 days following trip to ER for his finger

A 40yo experienced worsening of severe depression, PTSD, and passive suicidality in ICE detention. He was afraid to report medical complaints (chest pain and flank pain with a medical history significant for prior ureteral obstruction) because he was afraid of the mental health suffering he would experience in medical isolation for COVID.

A woman with Multiple chronic conditions ready for release and got COVID.