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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, MA CDR, US Public Health Service U.S. Department of Health and Human Services

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Continuity of tb therapy for u s immigration and customs enforcement ice detainees an update l.jpg

Continuity of TB Therapy for U.S. Immigration and Customs Enforcement (ICE) DetaineesAn Update

Advisory Council for the Elimination of Tuberculosis

March 20, 2007

Diana Schneider, DrPH, MA

CDR, US Public Health Service

U.S. Department of Health and Human Services

Health Resources and Services Administration

Bureau of Primary Health Care

Division of Immigration Health Services


Ice custody l.jpg
ICE Custody Enforcement (ICE) Detainees

  • 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


Slide4 l.jpg
Service Processing Centers and Contract Detention Facilities that House U.S. Immigration and Customs 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


Tb among ice detainees l.jpg
TB among ICE Detainees that House U.S. Immigration and Customs Enforcement (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


Slide6 l.jpg

U.S. Immigration and Customs Enforcement Detainees Active Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

Release Status

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


Tb continuity of care processes l.jpg
TB Continuity of Care Processes Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

  • 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


Stays of removal l.jpg
Stays of Removal Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

  • 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


Challenges l.jpg
Challenges Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

  • 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) Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

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

    • 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


Workgroup recommendations 2 l.jpg
Workgroup Recommendations (2) Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

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

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

  • 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


  • Next steps l.jpg
    Next Steps Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    • 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


    Acknowledgements l.jpg
    Acknowledgements Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    DIHS 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 Duchesne

    El Paso, TX : LCDR Erik Hierholzer, LCDR Zita Guerrero, Dr. Rosa Colon, LCDR Chiara Rodriguez

    Elizabeth, NJ:, LCDR Rusty Waldron, LT Jonee Mearns, LT Raymond de la Peña, Dr. Chang Park

    Eloy, AZ: LCDR Melissa George

    Florence, AZ: CDR Claire Karlson, Dr. Elizabeth Fleming, LT Marc Winoker

    Harlingen, TX: LCDR William Rekward

    Houston, TX: CAPT Christine Williams, LT, Monique Frazier, LT Cynthia Beard

    Los Angeles, CA: LCDR Jason Ortiz, LTJG Katherine Maye

    Miami, FL: CDR Kirsten Warwar, CDR Jaime Muñiz, Dr. Abelardo Montalvo, LCDR Andrew Ganzon

    Pearsall, TX: CAPT BuJean Jenkins, Dr. Erik Johnson, LCDR Gina Chacon

    Port Isabel, TX: CAPT Marian Moe, LT Maria Morel, CDR Adolfo Zorilla, Dr. Luz Peredo-Berger

    San Diego, CA: LCDR Steve Gonsalves, Dr. Ester Hui, LCDR Bonnie Saylor

    San Pedro, CA: LCDR Chris Henneford, LT Shelly Hollandsworth

    Stewart, GA: CDR Lynn Harris, CDR Sherlene Jacques, CDR Betty Shaw

    Tacoma, WA: LCDR Deanna Gephart, LT Christine Chang, Dr. Phil Farabaugh

    Taylor, TX: LCDR Tom Hochberg, CDR Peggy Mathis, LCDR Angel LaSanta

    Willacy, TX: CDR Dawn Anderson-Gary

    Headquarters: Mr. Neil Sampson, Dr. Tim Shack, LCDR Alice Fike, Ms. Jennifer Cheng


    Acknowledgements14 l.jpg
    Acknowledgements Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    • 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


    Contacts and information l.jpg
    Contacts and Information Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    • Division of Immigration Health Services

      Diana Schneider, DrPH, MA

      phone: (202) 732-0070

      e-mail: Diana.Schneider@dhs.gov

    • www.ice.gov

    • www.dhs.gov/immigrationstatistics


    Objectives l.jpg
    Objectives Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    • 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


    Ice custody17 l.jpg
    ICE Custody Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    Border

    apprehensions

    Transfer from other law enforcement entities

    Special Missions

    Interior Apprehensions

    Often poor or no documentation of previously diagnosed medical conditions

    Intake Screeningincludes TB screening


    Slide18 l.jpg

    U.S. Immigration and Customs Enforcement Detainees Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005

    Active 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