Family detention centers “routinely” utilize solitary confinement or “medical isolation” on parents and their young children, according to advocates and attorneys who spoke to Rewire.News.

Court documents obtained by Rewire.News detail the turmoil of families held in isolation, typically in medical quarantine and with no information about their case or when they might be released.

In February 2018, the Berks County Residential Center, a family detention center in Leesport, Pennsylvania, held at least two families in medical isolation. In one instance, a Haitian father and his 3-year-old son were quarantined for two weeks. In another case, a Haitian mother and her 3-year-old son were isolated for more than five days.

“I feel so sad because my son and I have to stay in our room all day long,” the Haitian mother wrote in documents redacted to protect her identity. “When I want to go outside my room, the staff say on the intercom, ‘The Haitians are coming.’ … They clear the hallways and make the other families run away.”

“My son and I aren’t allowed to talk or comingle [sic] with anyone,” she added. “We don’t go outside. We’re stuck in our room that says ‘restricted area’ on the door. At mealtimes, the staff puts the food behind our door and leaves. I don’t understand how they could treat someone like this. I feel like I’m being discriminated against… for being Black and Haitian. My son and I are the only Black people detained here.”

Attorneys with RAICES, which is representing immigrant families detained at the Karnes County Residential Center in Texas, told Rewire.News that families there are “routinely put into medical quarantine,” but they “haven’t heard of this happening lately.” Something similar was said about the South Texas Family Residential Center in Dilley, Texas. “While we have heard of one or two cases of people held in isolation as a punishment, it is normally because they have an inconclusive result tuberculosis test, [and it] normally turns out they do not have [tuberculosis],” Katy Murdza, advocacy manager of the American Immigration Council’s Dilley Pro Bono Project, said in an email.

Sofia Casini is immigrations program coordinator at Austin-based Grassroots Leadership. Berks is one of three existing family detention centers in the United States; the other two are based in Texas, where Grassroots Leadership has been fighting to get them closed. Casini told Rewire.News that using solitary for medical issues is “not at all unprecedented.” However, if medical tests are “coming back negative and families are still being isolated, that is very concerning.”

The documents reviewed by Rewire.News suggest families in detention have been held in isolation for “inappropriate” periods of time, as one doctor put it, while not exhibiting symptoms or seeing conclusive results.

U.S. Immigration and Customs Enforcement’s Family Residential Standards feature an entire section on handling TB cases, including reporting standards and post-custody case management for therapy continuation, though no protocols for the use of isolation are outlined.

An ICE spokesperson said in an emailed statement that, as tuberculosis is spread through the air from person to person, its facilities’ standard practice for screening, testing, and treatment is consistent with the Centers for Disease Control and Prevention‘s.

As to why a family would be held in isolation for up to two weeks, the spokesperson said, “It would depend on the patient’s initial clinical presentation, i.e., whether she had symptoms consistent with TB disease, chest X-ray findings, AFB smear results, and NAA test results, and clinical and laboratory response to treatment if empiric treatment was indicated.”

An ICE directive specifies that the use of solitary confinement is considered a “serious step that requires careful consideration of alternatives.” Detained people should only be placed in isolation “when necessary and in compliance with applicable standards,” and administrative segregation due to a “special vulnerability” should only be used “as a last resort and when no other variable housing options exist.”

But as Splinter reported in February 2018, advocates are increasingly saying “guards may be putting detainees in solitary confinement for arbitrary reasons, such as getting sick or pushing for proper medical care, overlooking national standards that give them specific rights in these situations.”

This is especially concerning in the context of family detention because the Trump administration is fighting to loosen the already lax restrictions for detaining children outlined in the Flores settlement agreement. If the administration gets its way, children will be subjected to prolonged detention without legal recourse.

It seems increasingly that younger children are now being detained as well. The South Texas facility is reporting young infants, some as young as 5 months old, have been held at the detention center with their mothers.

“The Flores settlement is really one of the pillars of how children are treated in the immigration system in the United States,” said Paige Austin, staff attorney at the New York Civil Liberties Union. “Undoing it, canceling it, and replacing it with this alternative set of regulations would go a long way towards realizing the [anti-immigrant] rhetoric that [the Trump administration] has been using,” Austin said.

The attorney further noted that undoing Flores could be especially concerning at Berks. “We’ve seen these abuses at Berks for a long time, and families there have already been subject to extremely lengthy and harmful detentions. So, it’s not to say that the harms inflicted on children and on families were not occurring, but I don’t think anyone was proud of them in the way that this administration seems to be proud.”

“A Hopeless Place”

Berks, which is operating without a state child-care license, has become notorious for human rights abuses against vulnerable immigrant parents and their children. The Guardian reported in January of a 2-year-old vomiting blood for three days, and another young child who in 2015 contracted a skin disease that spread to his genitals and bled when scratched. Berks’ clinical team reportedly did not provide medication to him. And in April 2018, Rewire.News reported on the story of Astrid, a 15-year-old girl who was detained at Berks alongside her father for 32 days. While there, Astrid said she was the only female in what was an all-male facility. (The demographics of the facility change depending on who is being detained.)

Carol Anne Donohoe, an attorney with ALDEA-The People’s Justice Center, who represents Berks families, characterized the situation at Berks as “completely abhorrent,” and she is “confused” as to why officials allow the detention center to continue operating.

“Counties all over the country are severing their contracts with ICE, but that’s not happening here,” Donohoe said. Berks County “has actually spent hundreds of thousands of dollars in legal fees to fight this licensing issue so that it can continue detaining families.”

Donohoe has filed countless complaints with Berks County officials and child welfare services, hoping someone will use their power to “aggressively investigate violations” at Berks. But the family detention center almost seems “indestructible,” the attorney said, and her clients characterize it as “a hopeless place,” she said.

In March 2018, Donohoe brought the case of the father and son placed in isolation for two weeks to the attention of Teresa D. Miller, secretary of Pennsylvania’s Department of Human Services (DHS). In an email dated March 1, 2018, Donohoe explains to Miller that Berks’ staff gave the father and son TB tests on February 18 and then placed them in medical isolation. The child’s test was negative and the father’s was inconclusive, according to the attorney.

The father was subsequently taken to the St. Joseph’s Medical Center in nearby Reading, which is part of a Catholic health-care network, for an X-ray. (Catholic health providers typically object to providing patients with the full spectrum of health care, often denying certain reproductive health services, as Rewire.News’ Amy Littlefield has reported.) The doctor spoke to Berks staff members and not the father, never communicating with him in Creole, according to Donohoe’s email. The attorney maintains that the father was not told the results of his X-ray, and instead, he and his 3-year-old son were held in isolation for two weeks. Whenever they needed to leave the room, staff members would announce on the intercom “for everyone to disperse” because the family was coming.

In an emailed response to Donohoe, nearly one month after the attorney expressed her concerns and the father and son were released from detention, Pennsylvania DHS chief counsel Doris M. Leisch shed light on the intake process at Berks, which includes “tuberculosis pre-strain,” a TB test that is read within 48 hours.

After the father and his 3-year-old son were initially tested on February 18, they were released into general population at Berks, according to Leisch, but the father’s results came back abnormal on February 18, so he was taken to a medical facility for a chest X-ray. According to the chief counsel, the results were “abnormal for TB,” so when the father and son returned to the detention center from the hospital, they were placed in “negative pressure isolation,” which is typically used in hospital settings to contain airborne infections. On February 19, medical staff began “the work up for TB,” Leisch wrote, which included more blood work.

“The protocol requires a daily visit from a provider, who monitors the resident for signs/symptoms, appetite, vitals, blood pressure, mental health, and blood work,” Leisch said in a May 29 email to Donohoe. “During the provider visit on February 19, the doctor documented ‘active TB could not be ruled out.’”

According to Leisch’s email to Donohoe, the father and his son were ordered to remain in isolation, though the father “denied any complaints or signs or symptoms and asked why he had to be there, since he did not feel sick.” An epidemiologist determined the father had to start a five-day course of TB medication on February 24. Though his son tested negative for TB, the 3-year-old remained in isolation with his father until March 1. His father, however, never received a positive diagnosis for TB, according to an overview of the father’s medical records and statements from Pennsylvania DHS chief counsel.

“Medically, This Doesn’t Make Sense”

Dr. Katherine Peeler is a pediatrician and member of Physicians for Human Rights’ (PHR) Asylum Network, a group of volunteer physicians who conduct forensic medical evaluations of asylum seekers, documenting evidence of physical and psychological trauma to be submitted as part of an asylum application. Peeler has visited Berks and is currently writing a paper on the adverse effects of sleep deprivation on children detained there. (It is well documented that each night, Berks staff shine flashlights into bedrooms every 15 minutes, waking sleeping parents and children.)

Rewire.News provided Peeler with the court records related to the two incidents of isolation at Berks, and the physician contended that TB skin tests are tricky and are not as simple as positive or negative.

A tuberculin skin test (TST) is the most common test used to see if a person has been infected with TB bacteria. According to the Centers for Disease Control and Prevention, a small needle injects a liquid called tuberculin into the skin of the lower part of the arm. When injected, a small, pale bump will appear. The person given the TST must return within two or three days to have a trained health-care worker look for a reaction on the arm where the liquid was injected; they are looking for a raised, hard area or swelling. If present, they measure the size of the raised area using a ruler.

If the results of this initial TB test are positive or inconclusive, a chest X-ray is warranted. The results of the chest X-ray should be read “in context,” Peeler said, meaning after speaking to the patient and determining whether they have any symptoms. Symptoms vary depending on where in the body TB bacteria are growing, but TB bacteria usually grow in the lungs, which causes a bad cough, pain in the chest, and sometimes coughing up blood. The father subjected to medical isolation exhibited none of these symptoms, according to Donohoe; the court filings do not mention any symptoms either.

“An X-ray should be read very quickly with no lag time,” Peeler said. “It’s hard to say why they couldn’t come to a final diagnosis. In speaking to a colleague who is a pediatric infectious disease specialist about this case and the limited information we know, we still came to the same conclusion, which is that we couldn’t think of any scenario where it would take two weeks to officially diagnose TB.”

Subjecting a person to isolation for two weeks should also depend on whether the TB was active or latent, meaning a person actively has TB or is chronically living with it, said the doctor. Based on court filings, including emails between Donohoe and Pennsylvania officials overseeing Berks, the father didn’t test positive for tuberculosis, either active or latent. In hospitals, Peeler said, a person diagnosed with active TB is placed in isolation during their treatment, meaning they are in a private room and everyone who interacts with them must take special precautions, including wearing a mask and a gown. There is also protocol for entering and exiting the room.

Peeler said there is a “functionality” for isolation, and if the likelihood of tuberculosis was low for the father, he and his son should have been taken out of isolation.

“Two weeks in isolation without an official diagnosis is inappropriate—especially when you consider that this man’s child was also in isolation with him. It’s not appropriate for the child from a psychological perspective,” Peeler said.

The ICE spokesperson said in a statement it is standard protocol to keep children in isolation because “it is assumed that household contacts of people with TB disease are already exposed.”

When asked about whether there is any guidance on how long a child can stay in isolation, the spokesperson explained that there isn’t specific guidance on this. “It might depend on whether alternate childcare arrangements are available,” the public affairs officer said.

Kathryn Hampton, who coordinates Physicians for Human Rights’ Asylum Network, told Rewire.News that PHR has been studying the impact of detention on asylum seekers, and the organization has found a clear correlation between detained people and deteriorating mental health. Solitary confinement compounds the trauma that people feel, Hampton said, especially because detention centers are non-therapeutic environments.

In 2011, the Special Rapporteur for the United Nations’ Human Rights Council released a report stating that confining prisoners in solitary beyond 15 days is “torture or cruel, inhuman or degrading treatment, or punishment.” Hampton, who said she was “shocked” to learn from Rewire.News that detained parents and young children were being subjected to isolation together for as long as 14 days, noted that it should be considered a “child rights violation” that is “clearly not in the best interest of a child.”

“Even if we give this detention center the benefit of the doubt and say they had good intentions, it’s important that the American public not underestimate how traumatizing these facilities are. On the news, [detention center] staff will point to some coloring books and imply being detained is like being in school. It’s not,” Hampton said. “These are families fleeing violence who then get locked up and have every part of their day controlled. It’s like prison. When you add solitary to that, so that kids can’t leave a room and play or be around other children, it’s horrifying to think about.”

Peeler added that from a health standpoint, it’s not the best decision to put someone who doesn’t have a medical condition in isolation with someone who may have one. “If you’re concerned the father has active TB, you’re exposing the child to active tuberculosis by putting them in isolation together,” Peeler said. “And because this is family detention, if you separate the family, which has likely already experienced trauma, you’re taking the child from the only person they know. That is its own ethical concern.”

In her email to Donohoe, Leisch said that the father’s 3-year-old son stayed with him in isolation so “the parent and child would not be separated,” and the chief counsel maintained that both Berks and hospital staff at St. Joseph’s communicated with the father in Creole, something Donohoe and the father deny in court documents. (The Pennsylvania DHS did not respond to Rewire.News’ request for comment by publication time.)

If both Berks and hospital staff failed to communicate with the families subjected to isolation in Creole, it would be a violation of ICE’s own medical care standards and St. Joseph’s patient rights.

“Just because you are in custody does not mean your rights should be disregarded,” Peeler said. “How do you get a person’s symptoms or medical history if you don’t speak to them? You can’t diagnose someone if you never asked them about their symptoms. Medically, this doesn’t make any sense.”