Jurisdictions collide: Public health vs. INS
Jurisdictions collide: Public health vs. INS
Incidents don’t reflect policy, says spokesman
In two recent instances, agents who work for the U.S. Immigration and Naturalization Service (INS) are said to have denied TB victims the treatment they needed and put others in danger of exposure to tuberculous (as well as AIDS)..
In Sacramento County, CA, an infectious tuberculosis patient co-infected with HIV was jailed for noncompliance. Because he was an undocumented alien, he was seized by INS agents and placed on a bus bound for Mexico. Public health authorities tried unsuccessfully to obtain information about where the patient had been sent. Later, the patient crossed the border back into the United States and turned up in jail once again. Though he’s said to be suffering from full-blown AIDS, he’s finally completed his anti-TB regimen.
Suspect released onto the streets
In DuPage County, IL, INS agents took an undocumented worker to the local jail. A week later, the man was found to have infectious TB. Authorities at the jail told the INS to retrieve the prisoner, and after several unsuccessful attempts on agents’ part to persuade homeless shelters to admit him, the man was released onto the streets. His case came to light after his lawyer went to court for his deportation hearing, found him missing, and made inquiries.
Such cases aren’t supposed to happen and don’t reflect INS policy, says Greg Gagne, senior spokesman for INS headquarters in Washington, DC. "For people with an infectious disease such as TB, INS policy is that we don’t bond people out, we don’t put them on the street, and we don’t deport them," he says.
For patients with active but noninfectious TB, "we give them the appropriate medications and instructions on how to use them and send them home." Exceptions to that policy, he adds, "are anomalies and result when either someone is misinformed, has misconstrued something, or both."
Keep communication lines open
The best way to avoid such incidents is to maintain proper communication with immigration and correctional authorities, experts say. "Awareness, education, and dialogue are all essential," says Subroto Bannerjee, TB controller for Alameda County, CA. "Of the three, dialogue is the most important. If there is an INS holding facility, as there is in Alameda County, I make sure that we meet with [INS staff] and that we have a channel to talk to them."
Nationwide, in some counties, the INS has its own holding facilities for detainees; in many locations, however, the agency uses local jails or prisons. Human rights groups, notably the watchdog organization Human Rights Watch, have condemned the practice of housing undocumented persons in prisons alongside criminals.
Bannerjee says he’s not aware of instances in Alameda County where the INS has taken custody of a TB patient without the knowledge of public health authorities. But in Sacramento County, TB controller Luis DeSouza, MD, says he’s heard of other such cases. "I know of at least three other cases where people just disappeared because Immigration moved them out," he says.
In the case of the patient co-infected with HIV and TB, DeSouza says he was frustrated in his attempts to get information from the jail and the INS. "One day he was there; the next day he was gone, sent across the border," DeSouza says. "I don’t know how many people he may have infected on the bus, but I’m pretty certain it’s a long drive from Sacramento County to wherever he went."
DeSouza isn’t sure how the INS discovered the man was undocumented, he adds. "We don’t report people as illegal," he says. "But there must be some kind of connection."
He says attempts were made to find the patient in his hometown in Mexico. Eventually, he resurfaced again in the United States as TB controllers had suspected he would. But by the time he was found for the second time, "he was almost blind from AIDS," DeSouza says.
Since then, INS and public health authorities have met to talk about what went wrong and how to keep such an episode from being repeated.
Human rights group denounces abuses
In DuPage County, IL, INS agents routinely use the local jail to house those suspected of being undocumented aliens, says Jennifer Bailey, JD, a research associate with Human Rights Watch. The human rights group recently released a scathing report that detailed a variety of abuses of detainees by jailers over whom the INS has no control.
In DuPage County, a week after INS agents had taken a Honduran man to the county jail, he began exhibiting symptoms of TB, says Bailey. County personnel notified the INS and asked that the prisoner be removed, she adds.
INS agents attempted to place him in a couple of local shelters, but they refused to accept him, according to Bailey. Eventually the man was released onto the streets, she says.
In court, Roy Petty, former director of the Midwest Immigration Rights Center and the attorney for the Honduran man, asked what had become of his client, Bailey says. "They looked up the case, and said, Oh yes, he’s been released.’" says Bailey. "But this man had no resources. He had nothing."
Petty, now an attorney with the American Immigration Lawyers Association in Washington, DC, never heard from his client again.
To make certain such instances don’t happen, agents who don’t adhere to INS policy need to have a clear understanding of the consequences, says DeSouza.
"The law clearly says that if a patient is going to be released from the jail system, the health officer must be notified," he says. The INS agents "know the telephone number [of the health officer], and there is the law," says DeSouza. "But the law does not say what happens if someone breaks it. Who is the INS responsible to? Someone has to be responsible."
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