Transcripts For CSPAN2 Hearing On Conditions At Immigration Detention Facilities 20240713

Once they arrive in customs and Border Protection custody. [inaudible conversations] s with this subcommittee on border facility operations todayod people will receive testimony how to prevent child death and custody. We can declare recess at any point. Chair asking them as consent we can sit and question the witnesses. Without objection so ordered. Jacqueline mckeen, seven years old. Felipe gomez alonso, eight years old. Darlene cordova, ten years old. Juan gutierrez 15 years old. Willll mayor one wilmer ramirez, two years old. Carlos fernandez, 15 years old. These six children died in the custody of the United States government in the past 18 month months. They were migrants from Central Americaa who died of preventable conditions that went untreated. The last hours of their lives were in detention facilities on the southern border we must never forget their names or suffering or the losses their family has had to endure. We are here thiss morning to examine the conditions that led to the tragedy brick we have seen a dramatic increase in the numbers of families and children arriving on the southern border over the past several years. Most of theseveve arrive in Central America with Gang Violence and extreme poverty. After surviving long dangerous journeys but instead they encountered the administration with the inhumane border policies with zero tolerance and remain in mexico policy. These have contributed to mass overcrowding at customs and Border Protection facilities across the southern border. To confirm these intolerable conditions i see these facilities with my own eyes as well as my Congressional Colleagues today. Dhs has consistently failed to maintain transparencyy to stymied congressional inquiry that raises concerns they are hiding serious issues of managementar in addition to leadership vacancies at the top of the department. One example on the death of carlos basque as. A teenage boy from guatemala who died tragically in us custody in 2019. Cbp issued a press release calling it a tragedy to d declare they consider the health Inhumane Treatment of migrants to be the highest priority. But the information requested not until a report was released seven months later that we learned more about what happened. It may have been caused by failure to provide urgently needed medical p care and failure to follow the basic procedures to check on the sick child. The case is still under investigation the lack i of transparency is unacceptable for call the office of thehe Inspector General is doing everything in its power to examine the factors that led to these tragedies so thats im extremely disappointed the current dhs Inspector General declined our invitation to testify this morning that the office closes its investigation into Border Patrol custody. Publicly available summaries are extraordinarily narrow in scope. Focusing only on dhs personnel committed malfeasance and if the policies and resources could protect the children in their care. Even with those two reports we still do not know why they were in custodyay for six days before they passed away. I along with other members of the committee remain concerned that dhs is not doing enough to protect the children in custody. So cbp continues to detain families with Young Children in need of medicaln n attention well beyondey the 72 hours. This is a disturbing pattern or we risk losing more children to preventable deaths in the future. We must act to ensure the policies and decisions that contribute to the tragic death are addressed. I hope the Witnesses Today are prepared tone explain whether the current approach after these tragedies how they intend to safeguard children Going Forward as members of congress we m may disagree, but there should be no disagreement the federal government must take responsibility for the human beings in its custody, particularly Young Children. Never forget jacqueline, felipe, darlene, wir , carlos and never let this happen to another child again. I think the witnesses for joining us i recognize the Ranking Member for his opening ngstatement. Thank you madam chair and the professionals. And for being here today here the actions dhs has taken and then with her migrants arriving at the border to address preventable deaths in custody. The crisis last year was real not the default of cbp or the executive branch or the president of the United States. The truth is this past year we saw a record numbers of family units of unaccompanied minor minors, large groups of 100 migrants, 213 groups to be exac exact. During the height the flu thason with months of extreme heat. At the time the Border Patrol was referring 50 cases per day to medical professionals. The crisis was legal loopholes. Activist judges and propaganda. And in 2014 under the obamama administration the numbered of unaccompanied minors encountered at the border was crisis level. Former dhs secretary johnson writes a letter to Central American parents to not send their children. It is clear that his actions were not taken at that time. If that was a crisis than theres no words to describe what we experienced at thehe border fiscal year 2019. Not only 321,000 miles the family unit apprehensions are more than 590 percent this clear 19 compared to fiscal year 14. Throughout the crisis most facilities were at war over capacity cbp personnel working overtime more than a month without pay to process the large groups. Resourcesth were depleting as key personnel were furloughed. Cbp Law Enforcement officer still scrape together enough money out ofhe their own pockets to buy toys and bring extra supplies for the migrants and their custody. And to the best of their ability. After a 35 day shutdown in 2018 the federal government reopened and the crisis continued. In light of the growing issues with the mass influx of migrant migrants, President Trump made an official request of supplemental funding for the border. My colleagues across the aisle blocked the vote on supplemental assistance more than 15n times. While leaders of the majority repeat the message like fake emergency the Border Patrol was testifying in front of congress that without the in funding we may quote unquote lose the border. Homeland security advisor reported on the crisis stating the delay in passing the supplemental unaccompanied minors to be held in custody of facilities for dangerous links of time. Members on this committee voted against the emergency supplemen supplement. A no vote meant keeping unaccompanied minors in custody instead at hhs facility suitable for children. Meant thousands of migrants and the sheriff testified before the committee that during the crisis, social Service Resources that should address local issues like homelessness are now completely able to do so while the men and women were struggling to keep the lights on at the border they were subject to partisan attacks. What even claim the deaths of children in custody were c intentional. Another statement and absurdity that there was no misconduct or malfeasance upon completion of the investigation of the deaths of those in december 2018. Every life is precious at is why i encourage and i am encouraged to learn about the immediate steps to enhance their ability to diagnose in custody and work with the chief medical officer for needed longtermrm improvements. The secondary medical judge ordered every child in custody and internalnd evaluation since then with an approach for those interviews for the initial process all on unaccompanied minors. On top of that cbp now has over 700 medical personnel and contractors stationed across the southwest border to provide medical support to migrants in custody we look forward to hearing from the witnesses held the medical capabilities have improved since 2018 the collaboration process between cbp office dhs and other relevant stakeholders customs and Border Protection ability to stop preventable death with their Expert Opinions how to prevent another crisis. Madam chair thank you for your indulgence and i yieldou back. Thank you the chair now recognizes the chairman of the overall committee, Mister Thompson for an opening statement. Thank you madam chair. Good morning to those of you who are here on the committee. The topic is sobering as it centers on the death of innocent children now in a rapidly changing political environment it can be easy to move on quickly from past disasters. The Trump Administration contributes to the situation exhausting the public and the mediaov organizations. Lities mef congress to refuse to allow it looks disturbing and upsetting events fade into the past and help ensure that they are not repeated. We are here today to examine the treatment of Migrant Children in the custody of the department of Homeland Security in 2018 and 2019. I look at what changes may still be necessary. The tension of migrants did not begin with the current administration. But in earlier administration both democratic and republican officials took steps to avoid risk and their help and fixed it it looks Vulnerable People in custody. Under the Trump Administration, we now find the elderly, the infirm and the children in detention facilities, such as Border Patrol stations, not decide or equitable people for extended periods of time. On arrival and our southern border began to rise sharply in 2018, the decision to detain everyone there to severe overcrowding. The dhs also inspected the general and attorneys and members of congress including me observed and reported on the conditions inside they used to facilities for months. Cdp throughout this crisis, said they face severely constrained despite congress providing billions in humanitarian funding in early. In 2019. Standing room only failed. Inadequate Hygiene Products and family kept outside in extremely bearable temperature. This is commonplaces cdp facilities during the height of migrant arrivals last year. And second environment despite of illnesses, such as the flu are inevitable. Whether individual deaths cant be directly attributed to specific conditions in a given facility they are not. We need to understand whether the policies and Resource Management decisions made live the administration but lives in jeopardy. Congress can not allow dhs and cdp leaders to make poor decisions or ignore existing policies and law. Secure borders are priorities for our country and for all of us on this panel, and have been for decades. Art of our responsibility as members of congress, is to check actions live the executive branch. They are misguided. Hearing such as this are critical part of that effort. Ive strong objections to the policies the Trump Administration has been in place along our border. And they continue to endanger the safety of Migrant Children. Such as those who remain in mexico. I hope to hear from our dhs witnesses this morning that the department will take its responsibility for people in its custody more seriously Going Forward. One child dead, was one too many. Im eager to know what the Department Plans to do differently in order to safeguard Children Safety while in dhs custody. I think chairwoman and wrecking members from holding todays important during back. Civic thank you mr. Chairman. Other members of the subcommittee a reminding of the committee rules, Opening Statements may be submitted for the record. First witness, chief Law Enforcement operations of u. S. Border patrol. Department of homeland considered security. Is the chief of the Law Enforcement Operations Director at u. S. Border patrol headquarters in washington dc. Is responsible for oversight of the data law of Law Enforcement operations the Border Patrol sectors throughout the United States. In the physical advisor to the chief of Border Patrol on enforcement operations. He began to service with the Border Patrol open 1995, as been stationed in various sectors across all u. S. Borders and was promoted to the Senior Executive service in 2018. I second witness doctor alexander felt he spent as the senior medical officer for operations within the United States department of holland Homeland Security. In this role, is responsible for operation medicines across dhs in addition to countering goods, to the u. S. Worldwide. Previously he served as the chief of the Trauma Center at parkland Memorial Hospital as an assistant professor and trauma surgeon. The division of bird trauma and Critical Care at the university of Texas Southwestern Medical Center printed doctor eastman is also decorated Police Officer within the Dallas Police department. Without objection, the false statements will be inserted in the records. I now ask each witness to some ricin statements for five minutes. Beginning with mr. Hastings. Good morning chairman rice, and members of the committee. Cdp mission is to safeguard americas borders. Please complete the initial processing of individuals in our custody before transferring them to our partners. Our Holding Facilities were designed for only short forum. We take seriously our responsibility to take care of they used to people. In 2019, cdp apprehended more than 1. 1 million people. In december of 2018, we began alerting congress and the media and the public that an unprecedented spike in Central American families and children was creating a crisis on our southern border. For months a request for legal and emergency funding was unanswered and we begin diverting resources from our Border Security mission to address the crisis. And i prepared to testify before you today, reflected on numerous cdp has taken and continues to take in response to this crisis. Can not be more proud of the extraordinary efforts undertaken live the men and women of cdp. I would like to share with you many examples today of the challenges we face and our Rapid Actions to address them. First is the average pensions skyrocketed, we had more people interesting than we could prioritize. We followed live families in the live single adults. Cdp search more than a thousand 50 officers and ages to the beasts of the busiest sectors. As many as 40 to 60 percent of our agents were diverted from securing the border to caring for those in our custody. Over 700 dhs personnel provided support our facility and we expanded our transportation contract and purchase more than 200 buses and vans to expedite transportation of large groups of migrants. We toured planes and busloads of 42000 people from facilities with more processing capacity. Second, even when processing was complete, i. C. E. And eight dhs has limited capacity to accept people. They contributed to furthering overcrowding the facilities. In march of 2019, Border Patrol began releasing noncriminal family units directly into the United States. Rather than transferring them to i. C. E. During fiscal year 2019, over hundred 45000 family members were released. Cdp rapidly constructed six offsite facilities and providing capacity for an additional 6500 families and adults. Live june, secretary lazar, stated that dhs shelters were full and they could not accept uac Border Patrol custody. When dhs received supplemental funding in july, people numbers drop down to 300. Third, we address the amenities for shortterm Holding Facilities were not designed to provide. Soft sided Facility Center highest volume stations, with portable showers, drinks and laundry, Climate Control systems and kitchen equipment. We expanded our Food Service Contract provide millions of males and start countless met snacks and water bottles, clothing and hygiene items. Finally we accelerated the expansion of our medical support program. Cdp issued medical directive in january 2019 which was superseded live an enhancement medical directive in december. Directive set forth foundational levels of medical support for cdp. That utilizes a phased approach through initial adverse observations medical interviews with a standardized help questionnaire, and medical assessments to a dignified potential medical issues and treatment. In the last year cdp has dramatically increased the number of contract medical professionals to more than 700. We built this capacity, u. S. Coast guard and public help Services Medical personnel were dispatched in many of our facilities. Now at any given day approximately 300 contract medical personnel, are engaged in more than 40 facilities along this southwest border providing 24 7 onsite medical support. Our medical support follow us a family practitioner model which is been observed and validated live medical experts. This ensures our medical providers are trained, licensed and credentialed. To care for all populations in our custody. Including children and pregnant women. Positions to include pediatricians provide oversight and training consultations for medical direction and medical quality management. And medical personnel may provide care men read prescriptions, and were recommending next year in local Healthcare Systems. Last year nearly 250,000 juveniles in more than 296,000 adults, received medical interviews. Nearly 60000 juveniles in more than 95000 adults, have received medical assessments. During fiscal year 2019, Border Control and 26000 people to a hospital or medical facility when advanced care was needed or requested. And they spent more than 19000 providing transportation to and from medical facilities in our hospital watch. They were the help of ordinary partners intergovernmental partners in the hemisphere, we have been effectively, set the border, the flow of aliens has grown live 792 percent. However, initiatives like the supplemental funding are only temporary fixes. As we said many times before Congress Must close the loopholes in our Immigration Service system that serves as actors. Were returning to our exceeding peak levels and overwhelming in our system yet again. I look forward to your questions. Thank you for your testimony. Good morning. It is an honor to be here today discuss the department of Homeland Security efforts to prevent child doesnt custody. Provision and expansion of medical care during the recent crisis. Im doctor and emmett d a chase. Been a practicing physician for nearly 20 years. In addition to my role here at dhs continued to be a practicing trauma surgeon. Immediately prior to coming to dhs site was the chief at the Trauma Center at Memorial Hospital. At parkland, we care for human beings from all backgrounds in it looks desperate times. To care for everyone without regards to race, color, creed, means, religion, quickly become apparent that when life and death are on the line, none of they used to things matter. Providing care for patients no matter the challenges, was my goal then, and is powerful now. From all of your missions to the border its nice to see you all this money. I know youre aware that we continue to improve the care for all people in our custody. Especially children. From the medical perspective, the quirks of this humanitarian crisis was a massive increase in the potential care. At times nearly 400 percent. Without that, it would pretty lock unique and help care system. Additionally, while correctional facilities have invented the Healthcare System Law Enforcement agencies do not. Cdp has primarily allowed enforcement organization. Never designed to have a Healthcare System within its goals. Doing so would be tens of building a Minute Clinic in every Police Station in america. In our challenge in the midst of this demand. Was an unconventional problem that required an unconventional solution. To help cdp in our own dhs components rise to the task of providing care to an overwhelming number of people including children in our custody. The extension tour we are today, the system currently in place, and the direction we are headed represents a herculean effort in response to an unprecedented challenge. In december of 2018, vha secretary direct the provision of immediate assistance with the rising humanitarian demands of the migration crisis. We immediately deployed and for the last 13 months, have been working on the border alongside colleagues from cdp i. C. E. Federal agencies like hhs and cdc, as well as state and local public help medical experts and professionals to improve the care of migrants and custody. With particular it tentative the children most of all the vulnerable adults. Our First Priority was to rapidly and urgently extend or medical capabilities long southwest 100 particulate cdp which has the biggest needs. In support of this vision the United States coast guard deployed more than 13 consent was border providing more than 3450 medical officers and more than 82795 help Service Technicians days of care. And this is the Rapid Response to this crisis for the Customer Service is our lifeline. Our Immediate Response of course from the medical standpoint, america should be grateful for the truly lifesaving intimate work of the coast guard during this crisis as well as the many others. Dhs also received critical assistance on the United States public help service. Our nations assistant secretary for help admiral himself pediatrician and intensivist was a critical partner and facilitated the target department of public help service law officers during the critical areas. No more than 4795 help Service Officers deployed to the border. There were totaling nearly 650 thousand days of my marriage. Note no mission was too difficult. Including loading into helicopters going to it looks remote Border Regions to immediately begin assessing migrants and providing any care necessary as early as possible. When large groups overwhelm us in areas without public help service support, or coast guard assistance, we moved them there. They used to two organizations came so freely at the time and expertise, the officers and physicians and nurses who came down and save lives directly continued to do so with the legacy they have left a long southwest border. The intraagency was capturing the crushing search, the cdp was working diligently to build the system that was impaired with Emergency Response. As mentioned that system now includes among other assets, more than 700 contractor providers and enhanced counter mess medical directive that begins to lay out the path forward. Our approach to approve care has been collaborative. Weve been coordinating but also live building a continuing. For local and state departments. In calling upon none government partners to assist in a. They all agree that the approach is sound. We have the legal, moral, and ethical duty to care for those in our custody. The challenge was unprecedented, regarding unconventional solution and we responded. A dhs, and across the government, we remain committed to ensuring that individuals especially in our children, received appropriate medical care. Thank you very much. I look forward to answering your questions. Thank you all of the witnesses. Sumac early last month, was video footage of carlos who is being help in Border Patrol custody in may of 2019. The video shows him heartbreaking detail of his last hours of carlos is like. He was 16 years old at the time. He died in his cell just hours after Nurse Practitioner apparently recommended immediate medical care. In fact his body was first discovered live cellmate was another child is being help in detention. Understanding the specific case is still under investigation, what cant you tell us about the lessons cdp has more from this particular case. I would start live saying dignity and care of those are of the utmost important. Im a father, i have a granddaughter as well. I watched the video, i saw the same video from the video report and the video itself was public. As you know, the case is still under oig investigation. I cant speak to what the findings are. One thing i cant add is that i know that all of the video has been turned over and all of the items that we had in the video has been turned over to oig they have all of the video. Not just a piece as i understand those pulled from the sheriff news department. Specs are you insinuating that there is more, im not sure what youre insinuating. So as i said all of the video throughout the station, that day it has been turned over to oig. Sumac what is it show. I havent seen it i just know that it has been turned over. I was just curious that you were insinuating something. Sumac im just insinuating that we turned over all of the events and all of the video. What do you think could have been done differently, your review of the case, what do you think could have been done differently. Its been indicated that welfare checks were conducted on this young boy. This young team let the video, shows an increasingly sick carlos and vomiting up blood, winding around in pain until he falls unconscious on the floor and sell. This happened over the course of hours. So im wondering, is there fighting my your internal the review that maybe it wasnt understood the level of medical attention that he needed. When he was in the cell at that time. It. So certainly any Lessons Learned from any of they used to investigations, or any others but wont look at to make changes. I cant tell you that we did put out guidance to the field that any of those and i believe this was july, and went out any subject in our custody were receiving welfare checks every 15 minutes. They were being documented in our system of record printed. Human person that subject. Because thats what they are. They are people. Not subjects. Cant you tell what policies are in place to ensure that recommendations that you received from medical professionals, are actually followed and what measures exist to protect Healthcare Professionals who refused to clear patients for detention. Im assuming that the cb has with any child, or human in detention, and they go to a help facility. Is that correct. Thats correct. Sumac are you aware of the pressures you putting on medical professionals to release patients that they cant get back to their jobs at the border. No maam im not in fact in reviewing some of the it investigation material, i saw the contrary one of our agents actually asked for additional care and stood up for one of the children that was sick until the pp was down. So we have seen the opposite. It sumac a good story to hear. There have also been indications of help professionals feel intimidated and pressured live the cdp personnel to release patients into detention even when it is not medically indicated. They, it seems like the dr. Should be making the decisions of the cdp officers. What policies are in place to make sure that the recommendations of medical professionals are followed. Other policies. We have multiple policies. We work closely with the cw envy as well as our own office of support. We have medical staff that we have received contract and we are providing the best care that we cant. This is the family practitioner model. Doctor eastman, it is good to see you again. When you make recommendations for the medical care individuals. Are they followed live cdp. Is nice to see was well and yes, we work collaboratively c cdp. To advise and help implement the recommendations and in fact, we have our employees, the senior medical advisor sep and this team works collaboratively to implement the recommendations that are made with the hardy respect. And there are operational considerations as well pretty sumac when the children a mission, every single one of them, was very sick. They shouldve been hospitalized and they were released back into cdp custody. So that has to be, i would hope some effort to review where they used to mistakes were made. It was they used to children who were very sick, one who had a temperature of one of 5. 7. Thats when they were initially examined. I just dont understand how they cant even be possible. Rcp officers are the trained, and other not medical professionals but it doesnt take a dr. To see that a child has 105. 7 temperature. We do the absolute best we cant to provide the best care possible the children are custody. But theres not a mechanism for us at the department of Homeland Security to review the care that is provided outside of our system along this border outside of our committees pretty sumac have you recommended flu vaccine for detained migrants printed. In our approach to it is a comprehensive one. It encompasses all of the settings where care is delivered along this southwest border printed. Is everyone given a pushup. Sumac their vaccination strategy has resulted in more than 60000 vaccinations being given predominantly in the soap Stores Service corps. Our is to give the right vaccine to the right person. Will they follow the medical recommendations. Sumac the direction from the leadership of secretary to all of the acting secretaries work for have done the same. Do the right thing for the rights of the people in our custody. We all Work Together printed sumac i understand. Just a yes or no. Have you specifically spoken with the sector secretary about the medical recommendations. It. Yes maam, providing and we have continued this conversation printed. Thank you manager, request of an emergency supplemental assistance to address the crisis at the border on may the first 2019. It took two months of the money to a be approved live congress. And to get the field. Meanwhile the department of health and Human Services ran out of money. And and and Company Minor dead space. Please explain to the committee, the americans watching the series, Immediate Impact the supplemental funding have untested Border Protection operations, at the border and cdp news ability to move on that company and miners out of cdp facilities and into ones more suitable for children including professional medical care. Steve thanks for the question. As everyone is aware, who dealt with 321 children last fiscal year printed we have never seen this kind of numbers before. That quickly overwhelmed the entire system specifically in may and june timeframe hundred 44000 apprehension news inmate work progress in the end and missus volz the flow. The system we were still processing and about on average 25 hours average for uac. Uac could move. They were out of funding. They were out of money and they were telling us they couldnt move those in our custody. Live law, there is nothing more we cant do with the uac either. Other than turn them over to the hs. Thank you for that clarification. In the interest of perspective, the american citizens in the syrian and my colleagues on committee, just a is apparent that this insinuation that customs and Border Protection has in some way been neglectful. To carry of children and believe were all upset that the medical facilities of the United States of america and the hospitals of america, will provide some of the finest care in the world. Were investigating in the death of any child that is in the custody of the Border Protection. They should be investigated. The loss of a child is tragic. We take those deep breath looking at. But for the sense of perspective, we say that in 2017, alone 28308 juveniles died and professional medical facilities in the United States of america. They used to children they were struggling and no telling they have been through. Cdp does the best to take care of them. And tragically, sometimes children live including 28308 children in american hospitals in 2017 alone. Those are government numbers from the cdc. In our juvenile detention facilities, is not uncommon Historical Data from the government, sorry average of about ten deaths and a six year period. And juveniles in juvenile detention facilities in america. Much better designed and equipped to care for the children in their custody. Men and women wear badges care about the children that come under our care. I lost my firstborn daughter in the hospital. I asked many more on the street. A young teen hand. An unpaid drug debt. I sat there in the dock street pennell that omits and whispered prayer into his ear as lifelike led the way. Infant child and responsive to circle parents, i did my best to perform cpr to resuscitate the child. She didnt make it. After eastman, and my remaining 25 seconds sir, please respond to the spirit with which custom and Border Protection addresses in a sick child becomes into our custody. Sumac in my experiences serve, cdp officers Border Patrol agents and Law Enforcement officers most of them are parents as well. They packed exactly in the act exactly as you described to do the best they cant under the circumstances that they are adults. Sumac thank you gentlemen. This is the painful and necessary hearing. I think manager and the committee. For allowing us to discuss how we cant improve the care for our children become throughout border and let us not forget that we must operate based upon a cornerstone that defined america as we attempt to care for all of our children. I think you cant metal chair for holding the steering. Would you agree to taking 3. 5 million from a military Counterfeit Program would be problematic because there is reporting today indicating that the president is planning to divert some . 2 billion in pentagon funding to build his goal. We find that to be problematic in addressing they used to issues. Maam i would also add on the other hand, when a very large influx of families and children and we had a very in folks of single adults. We saw those numbers go up. I would also that we had hundred 47000 guideways that we know of last year. So they not only turning themselves and the people trying to elude as well. We need, this is the whole government approach to many things that we need to protect and safeguard our borders. Sumac do you think taking 3. 5 billion from a military Counter Drug Program is the problem to address the issues that they are talking. Yes or no printed sumac we need a border wall thats what i cant tell you. Answered the question i asked you. Sumac as the questioning and pretty. Do they used to problematic that the president i would 5 billion state will miller program. Is the reason we cant say as an apprentice techno pretty. Thats not problematic. Where we have needs on the border as well to secure our border. Animal construction is one of those. Sumac i read now recognize chairman for five minutes. Thank you manager rated the title of our subcommittee hearing today is assessing the adequacy of the dhs to prevent deaths in custody. My comments talked about one death in custody is too much. I understand this incidents have occurred, there is medical directive that talks about that we will no longer do medical assessments for children under 18. Are you familiar with that mr. Hastings. Our new policy and just going to affect is that we are doing help interviews for all of those less than 18. We are doing help assessments which is basically like a physical for all of those 12 and younger. Or anyone who says that they have a help condition or medical issue. So doctor eastman, are you familiar with that. So i guess our i am. Explained a little bit before the committee. Cdp is they used to approach, first to meet the medical needs of the population in our custody. The first phase involves recognition of illness and the encouragement and migrants to report to us that they have an issue. The second phase is the help interview that is been standardized across customs and Border Protection news using a questionnaire able to be administered live a Law Enforcement officer. When the twofold purpose. To identify an emergent medical condition but also to identify potential up Infectious Diseases that might threaten the United States. The third phase of that approach is the medical assessment from qualified providers prevent medical assessment in the local directive is given to anybody the positive findings on help interview. Or to any children under 12 anyone who requested. I have also onesided, the last phase of that care plan is for any true world emergencies, someone that would be cardiac care. Why would you determine then where the cut of this. The way the directive was derived was a collaborative approach from all of us involved. Dhs is cdp and other experts. The way the directive was approach was that a teenager would be able to seek and request medical care when necessary. What outside groups that you talk to when you did this assessment. The assistant secretary of help as i mentioned, several members of the staff overseas season the pediatricians in a direct addition, we worked with a number of public help Service Officers along this border who have vast experience from responding to a bola in disaster responses. And we hired a pediatrics with much experience. We also continue to listen to the groups that are involved in the carrying including the American Academy of pediatrics and family practitioners and other organizations are giving us advice on this topic. We continue to utilize the device to forum our policies and procedures. I am happy that you mentioned an american economy. I will letter from the American Academy of pediatrics. They say there is no medical justification to only assess children younger than 12. So i want to to seriously consider the group he talked about because they are the ones that are doing the children. And they are saying, 12 is not a magic number. And some of us are concerned. Between 18 and 12, is the vast shortage of opportunity for us to help children that were talking about here today. I just want to put that in the record. Mr. Hastings, why did it take department as long as it did to advise this directive. Are you familiar with that. We did an interim directive immediately in december. And we work with us various components that was mentioned earlier internally and externally, with our stakeholders to make sure we get this right. The interim policy was in effect since december of 2018. Additionally, we didnt wait to take action. We were taking many other actions including increasing our Contract Personnel even before that. Sumac so are you familiar with the class that subject to availability of resources and operational requirements. In. Resources and obligations and operational requirements. Im not sure what youre referring to. In the record you talked about developments. Swinging funny. It doesnt mention funding to continue our assistance resources is funding basically to continue the assistance with our contract radical providers. Suet sue makes decisions as to where the resources are available. Sumac is based on budgetary needs and the other thing. If we continue to receive funding to provide the Current Services we are and have Contract Services printed sumac you make the decision recuperated spak we have to be funded to continue printed. Im not talking about that. I am saying, who makes the decisions what individuals in the implementation of this down and flip directive. What you are referring to in state with the directive wouldve been very difficult when we were backed up in at 79500 children printed sumac so many say we, is that you print printed. That is the Border Patrol. Sumac symbol in the Border Patrol makes that decision printed sumac we would make it operationally and provide a heads up to congressional. So there is no individual opening that you cant give us this committee. As far as the amount of numbers in the resources we are using, consistently recap what we are saying on the situation and throughout the crisis we continue to break the summers printed we were overwhelmed is my. One talking about the directive. Im not talking about the conditions. You put a directive in place. You said subject to the availability of resources and operational requirements. I am asking you, who makes that determination. What individual. We will continue to do that. I would a nudge in that we go to the highest level. It will probably go to the chief of the commissioner to stop something that is important as this would certainly notify entities before forced into a situation overwhelmed, were not budgeted for this. I am having real difficulty, you not giving us a name. There is not a bad question. Somebody has to be responsible for making decisions on that requirement. Im just asking for my sake and i hope other individuals of the committee. Who is that individual printed. The commissioner. When advise like i said, i am not the chief of Border Patrol. I am the chief of operations. Oversee the operations in the field printed sumac so the chief of the Border Patrol, would interpret policy we are talking about now. In terms of resources and other things. When we did not have the resources to fulfill that obligation, that is what youre referring to ugly. Built, i am talking about the new policy was put in place in response to the death of the children and it is sad that is to the availability of the resources and operational requirements. And im just trying to get a sense of whos in charge of making those determinations. Again, we would have to be properly resourced to be able to carry this out with our contract employees printed we have to be properly and the have the proper funding to do that. Operationally, it would be the chief the commissioner that would pass this down and closely work with the field commanders and shes in the field printed. Manager, i think my problem is that weve had a problem and we had some proposed solutions. But we are not and im not comfortable with who is responsible for carrying it out. To the. That we might end up with another situation because the directive is unclear. And is subject to anyones interpretation. Im just trying to make sure that they used to problems dont happen again. I believe the witnesses attempting to answered that question to the best of his ability in u. S. One name. The answered is there are many names. The chain of command is the multitude of men and women that make they used to decisions on operational basis based upon what theyre dealing with in the field at the time and the report of chain and down chain. So the answered is, no ending. Ultimately, is of the highest levels responsible with implementation of a new policy will be based upon the word or work done throughout the chain of command spread is many people. You cant help me there. With the response. I am still, for clarity sake, if we come up with a new policy, manager, we might just have to fall out. The language request possibly. I think its not unreasonable if the policy is put out on an issue this critical, present and have those individuals who have passed with the responsibility of making sure they carried out. Ill back. Thank you mr. Chairman. Doctor eastman, and the fiscal year 2019, more than 200 large groups of hundred people more often of various ages, arrived along and more southwest border. Folks were coming to us after a long journey, many of them with the flu or another Infectious Disease that needed to be addressed. For those who were traveling hundreds of miles to our border, what was the likelihood that they had access to medical treatment along their journey . Im not the expert on the care that occurs from them reaching our southern border. Weve worked collaboratively with the government of mexico to try to help them do everything they can to improve conditions on the mexican side of the border. And i knew the department has a number of efforts in central and southern south america to facilitate other parts of this but im certainly not the expert they have been with these migrants as they presented to the border. Can you tell us more about that . What we see as seasonal influenza. Weve also seen sporadic cases of tuberculosis, chickenpox, we have seen some bumps and knock on wood superstitious. Can you tell us how many you estimate have been saved by the medical attention provided under the United States government custody . From the beginning of my work along the border, we know that about 10 of the migrants will wind up going to the medical assessment and those are rough early members of the crisis. How many were saved directly its hard to predict but there were lives that have been saved by the response to the crisis. Medical assistance from the Agency Partners like the United States coast guard medical teams and personnel from the Public Health service. How important is having additional medical staff on site as cbp facilities . Its important to remember that its a Law Enforcement organization. We think that healthcar health s best provided in healthcare settings. However, by virtue of the unprecedented crisis we face we had to mount an unprecedented solution and the terror that was initially provided by the first responders, the coast guard by the intermediate responders and Public Health service and then now subsequently placed onto the backs of the contract and medical providers, that care is vital. Its vital because weve got an unprecedented system, a problem in the system and that is a very unconventional solution. I know of no other Law Enforcement agency that ive ever interacted with or heard of that has developed healthcare infrastructure. The chief medical officers and coast guard i spoke to them daily and we, the department, received help from them and many other entities to provide what is clearly an unconventional solution to this unprecedented problem. And we thank you for doing that. Thank you both for coming here today testifying in front of us and i will yield back the remainder of my time. Thank you. Gentlewoman from new mexico. Thank you mr. Ranking member. In december of 2018, they died while in custody after being detained in the districts that i represent. Subsequently, the office of the Inspector General open an investigation. Three months later in the committee hearinacommittee heare former secretary testified she directed the office of professional responsibility and the Inspector General to work as quickly as possible to complete these investigations. Then, in may of 2019, my colleagues and i urged the department and the Inspector General to complete the investigation in a timely manner. They responded to the request saying that it was working to complete the investigations as expeditiously as possible. But it was only last month, nearly a year later after these tragic deaths that the investigations were completed and provided to congress. Even more concerning, the limited its investigation scope to only determine whether there was malfeasance by personnel and did not consider whether the policies and procedures are adequate to prevent my grandchild this. As ive said from the beginning, the reason for these investigations is not to punish people. Its to keep this from happening again. Its to make sure that we have protocols in place in case we are faced with this again. Its the committee is understanding that the investigations didnt interview medical professionals outside of the offices of the medical examiner and the department. This is unacceptable especially given the number of family units and unaccompanied children travel to thhavetraveled to ther leicester. Ni deeply appreciate the work that the men and women do every single day and in the past year to mitigate the situation that we saw at the southern border, and i want to find out whether the policies and procedures of the agency are setting our agents up for success to keep Migrant Children safe. As cbp received befor the four s of these investigations . I have not seen a full report ive seen an abbreviated report from office responsible. The officials. They were told by the oig that we have received reports. So, that is something we will followup on. I have not personally. I have not. From the information you received, have you identified a specific Lessons Learned as cbp took from the report and have recommended protocol changes to enforce them . I think one of the Lessons Learned is we need to standardize Health Across the board. All of cbp. One of the thing things we saw,e were multiple forms being used throughout this entire year is now standardized. And you have the updated form. Any other less than . That is one of the bigger ones. You visited the location. You are well aware of the remoteness and the amount of time that it would take to get even our own agent out of that area, so i think that you are very wellversed with the issues of remoteness and the rugged terrain that we had as well as transportation. Weve also added a large transportation bus to help. That is a great Lesson Learned and something im pleased Border Patrol is addressing. Do you have multiple buses now under contract . We do under contract and our own personnel that we have purchased as i mentioned earlier. What about the pediatric equipment and Lessons Learned from you one of the things is not having the appropriate cuff to take Blood Pressure. Is there equipment across the border that is available if necessary . We dedicated a large portion of the supplemental funding. We have over 100 emts in the field and we have updated them with equipment to make sure they have everything to meet their daily needs. And thats also part of protocol and is required if there is a deficiency the agencies have the ability to fill that. That is correct. I want to shift now to preventing the spread of Infectious Diseases. What are the protocols in place to protect both migrants and personnel from the spread of Infectious Diseases such as the flu inside of Processing Centers and ports of entry . With our Contract Personnel that we have in the southwest borders and about 40 locations, with those based on the highest vulnerable populations, the highest that we have seen as well as the least amount of medical assistance in the general area that is how we decide wherwedecide where to pud therefore we train and are able to provide any kind of testing. They are able to do that and give care and other things referred to secondary care. And you have written articles that support the theme . If you can supply those i would recommend that. We now recognize the gentleman. We want to speak to you on what we are currently experiencing along the southwest border. I know on page seven of your written testimony, you referred to fundamental flaws in the immigration system and go on to say that they are pleased to address the layers of the existing law and judicial assistance that adversely impact the ability to effectively manage our immigration system. There are three key gaps in the framework congress has yet to address and before the settlement you list the asylum and can you take a few minutes to expand on each of the factors that you listed we have the ability to hold in a setting that is providing expeditious information throughout the forceforces thats a major issur us completing that. When we release over 149,000 families, when we were interviewing these individuals, they literally told us that we were told to bring a child and we will be released. That is what is encouraging this large flow that we continue to see. With all the things provided, the double standard for the non continuous being able to return them to guatemala, honduras, other countries like we are currently with mexico and canada that would assist with the large number we are seeing across the border today and last, tightening the asylum bar to the low asylum bar for the credible fear we see the impact with over a million cases writedown. And would you agree that if the congress were to address these three issues that you have set forth in your report, that it would help the flow of illegal immigration that we have seen across the southwest border . Yes, we believe it wouldve. You were asked a question before about moving the shifting of money for the department of defense to our southwest border for the purpose of border wall construction. Do you feel it has improved the ability to protect the homeland . It comes with roads, Situational Awareness and time to respond. I see what it does to us and i strongly support it. Is there any other recommendation that you would think to this committee as to how we can better help your department again to secure our homeland and those within the custody that we could do our best to make sure they are protected. In the recommendationand the ree continue to fund hhs so we can move them through the cycle and to the proper environment for care. They would also request assistance with funding as well for the single adult bed space because that is another. Thank you for your service to the nation. I recognize ms. Clark. Thank you madam chair and i think the witnesses were testifying before us today. My colleague asked you whether a 3yearold girl code pose a National Security threat and you responded i dont know. I believe that we shouldnt be surprised when children dont receive medical attention they need particularly when we dont know whether a 3yearold can pose a criminal or National Security threat. Having said that, i introduced hr 3777. This is the National Commission to investigate the treatment of migrant family and children act which would create an independent commission to study issues like family separation. As well as the death of children in cbp custody. But short of passing the legislation, we have to revise on the Inspector General to get to the bottom of these matters and the report recently released by the dhs states that a Border Patrol supervisor had to pay out of their own pockets for overthecounter medication for an 8yearold because Border Patrol venture incident cover it. The cbp emt was unable to take the Blood Pressure because they lacked a pediatric cough. What steps have you taken to ensure access to basic medical necessities and equipment across the southwest border . Thank you for the question. So, we did indeed see an issue you were a problem with us being Border Patrol or cbp being able to find non prescriptions come over the counter perceptions. We have since fixed that and we have a contract to be able to purchase for any needed overthecounter remedy that is prescribed. So, we have that and additionally as mentioned earlier are able to provide equipment out in the field and those have been fixed. Wonderful. I appreciate that. We should be able to shift funding to save human lives particularly the human lives of children. We need to understand what went wrong in 2018 and 2019. If the official felt to take reasonable steps to prevent the death of a child, what kind of disciplinary measures do you think would be appropriate . Im just asking hypothetically. I would have to see everything that went into the report but if it was negligible certainly take immediate action. Have any official space accountability for the theft of children in custody . Theres been no negative findings of malfeasance. How do we determine, im sorry . How do they determine what expenses qualify as consumables or medical care . Is administered through ice. Provide examples of the type of projects or activities for which the consumables and medical care funds have been obligated or expended since the supplemental was enacted. Absolutely and thank you for the supplemental funding. In response to that in the more than 40 locations that now have a standardized formulary of medical care and equipment that is used to care for the migrants in custody, so that is a clear example of how its been appropriated from the supplemental to help further the care of children in our custody. And how is that replenished, how do these subcontractors im not an expert in their supplychain management, but they have a system that replenishes them and the supplemental pays for that. Very well. Madam chair, i will yield back the balance of my time. I recognize the gentleman from california. Thank you for being here today. Im a member of this committee as well as the Judiciary Committee where we have had numerous hearings concerning the dangers to the facilities that adequate standards of care for migrants including Young Children and like my colleagues here i am troubled by the multiple reports in the overcrowded facilities and actually ive toured some of those facilities and there is a general agreement that the cbp facilities were not meant to handle the influx of children and families that weve seen over the last two years. My question is what contingency plans as the department have in place to ensure the safety of those within your custody. There are a couple of things i would add as i mentioned in my opening. The facilities of complete wraparound medical food services, shower pretty much all amenities. And additionally, we plan long term to put a Central Processing Center is up in the busiest areas, primarily the rio grande area, those are actually buildings that are being completed now or will become pleaded anbe updatedand startedt they are actually being completed right now for el paso so making in other words having those facilities Wraparound Services is something we plan now and we have a longterm solution. Mr. Hastings, i know you are the chief of operations. When general kelly was the Homeland Security committee here he testified im going to paraphrase the Border Security goes beyond the border. And im thinking to myself we dont wake up one morning and say my gosh look at those folks at the doorstep. With other governments would they begin to see the flow of refugees and migrants moving so my thought is how do you prepare or are you preparing for those coming from not only south of the border from Central America but also other parts of the world i dont see this as a one instance phenomenon but rather to be continued to escalate as you have folks in harms way this is going to continue to be a challenge migration and refugee from around the world. Are you doing something to anticipate. We are embedded with multiple different governments in the northern triangle and have agents on the ground down there working with them now. Also working strongly with our mexican Law Enforcement partners on a daytoday basis. In addition to the Border Patrol does, the surveillance Information Center which is the cwnd entity with the chief medical officer works to continuously work with partners not just mexico but our partners across the border and worldwide to identify and begin to recognize healthbased threats to the United States. The operational challenges have prevented you from really vaccinating a lot of those individuals that need it. There are those that have come into the United States but have gotten vaccinations including and after this entire catchup particle at hhs weve administered more than 60,000 independent vaccines predominantly. So you are moving that direction and weve have doctors volunteering to get you up to speed to get there. That isnt a factor or you are doing fine on your own . It is a challenge because of the difficulties in utilizing volunteers and the difficulties with the licensure and administration, weve actually encouraged them to volunteer in the local government shelters and cbp have done work to try to dto places that can utilize them more. To followup on this issue of the challenges of having licensed doctors integrated into the system of actually being able to vaccinate some of these children and deliver services that maybe cbp isnt able to deliver because of limited capacity and if i can get 30 seconds, when you talk about mexico is trying to improve on their side of the border some of care are we coordinating at all in the mexicaand the mexican aun terms of making sure that health care disease doesnt respect the border but addresses both sides, so are we addressing . They made a visit last year and we continue to make the situation. Thank you gentlemen for being here today. I now recognize the gentleman from texas i appreciate the opportunity and thank the witnesses for appearing as well. To both of you, do you think the president seriously when he makes comments . You hear his comments. I dont know what you are referring to. I think it works from what ive seen it do in the field firsthand. So you think mexico should pay for the war i can tell you the mcveigh said mexico should pay for the wall. Im not involved in funding the wall. How many lives wouldve the wall have saved . Let me ask you this, are the people who seek asylum criminals i didnt ask the people crossing the border illegally. You know the society is, do you know the definition of the society . My question is are a people that are seeking asylum, are they criminals ask. We are asking them to good report of entry. That has little to do with my question. Why would you not state what you know to be the truth clacks are Asylum Seekers criminals . If they cross the border illegally. Where do you find this in the wall to support your position that people that are seeking asylum are criminals . Or diabetes criminals, this is why you treat them the way you treat him, you perceive them as criminals . Babies are not criminals. They have no malice or forethought. What would you recommend we do to prevent future deaths . Was takin taking a lot of the actions and have been taking them for quite some time. I think we are taking the right steps now to prevent further deaths. It will be difficult as we have explained to say we are going tg to prevent every death. The people we encounter on the border, many of whom have traveled over 2,000 miles or more and have never seen health care or have had a treatment, but we are running into them obviously many times and we are doing everything we can to get the treatment when that is the case. As i mentioned earlier, taking the actions for the double standards for the long continuous is one. Because we were unable to return them unless it is mexico or canada, and the making of a mentioned earlier, the fix being able to pull everyone together in the proper setting while they go through their expeditious hearing. For edification purposes, the uic assigned to be a pejorative. I still find it to be a pejorative. These are children. I am going to yield back the balance of my time. I now recognize the gentleman from illinois. Thank you madam chair for holding the hearing for continuing the important oversight work on the humanitarian situation of the southern border. During my oversight trips i volunteered and saw firsthand the need for the resources to improve medical recordkeeping. As a nurse i know how important it is when it comes to both Patient Outcomes and ensuring Health Care Providers to most effectively do their job. In response to what i is all i am so proud we passed Bipartisan Legislation last year President Trump signed an appropriations package that includes 30 million in dedicated funding for that health record. Yes maam thank you very much and thank you for passing. The model may allow us to effectively document the care that is provided, but they also allow easy access to the data to do things like quality assurance. We are able to measure the care we are provided and ensure that we are able to assess the quality of that care and learn lessons from that. In addition, the system that we intended to develop will improve our ability to conduct these techniques that will trigger the Infectious Disease before a human can pick it up. From your perspective, how did the providers that are communicating about this here . Electronic records are a complicated topic, but they allow us to describe the care that we have provided from the point of the pretension to the point of relation. Not only internally, the two help us communicate across multiple settings, but they also allow us to communicate to external partners and one of the things that i think is important in this hearing to mention is that the system that is provided not only protects migrants from a system that has been put together, it also protects the integrity of the Healthcare System and local communities and they would be overrun by the amount of care that is required. We have Electronic Health records and we know theyve already begun the process of building one for the cbp. Along with the dedicated funding, congress directed the dhs to come up with an Implementation Plan within 90 days. Can you give an update on where they are on the process and to what specific actions have been taken so far . Writenow we are in the process to identify some Immediate Solutions that can influence the technology thats out there and at work is ongoing immediately. We are also working to plan for the longterm. We have hired the officer that we think has the talent and expertise to help us build a system that will not only create an effective customized solution but harness our ability to help our readers do the job more effectively. Everything we do has to take into account the effect it has on the individual operator doing the job of the border at the Processing Centers and ports of entry along the border. What is the next phase in the implementation with h. Hr . The next phase we work our fingers to the bone to try to get a plan together to come back as to where we are headed. I will have to take the specifics of the question. Its been around five or six months. In your medical opinion why is it so important to ensure that its interoperable with those used with other components . We want to make sure we are able to provide a seamless picture of all of the care that is provided from the point for the provider to know what happened upstream for the care that is provided in the Border Patrol i appreciate those operational benefits. The other benefit of an Electronic Health record is obviously youre not missing information or losing patience or missing opportunities to identify Infectious Diseases or changes in current status. We are headed into another flu season and you noted in your testimony you are working with other Public Health agencies to improve response so what specific steps have they taken to strengthen its ability to respond to during this current flu season which we know has been particularly harmful and deadly for the rent throughout e United States. It appears that it is rough. They diagnose and treat the flu on the Law Enforcement side of the custodial side its been developed through the course of 2019 subcontracts support has been developing that capability has been put into place continuously over the years. Thank you madam chair and the witnesses for appearing today. I ask unanimous consent that the representative be permitted to sit and question witnesses. Without objection. I now recognize the gentle lady from texas is Sheila Jacksonlee for ten minutes. Madam chair and Ranking Member thank you for this important hearing and let me thank the witnesses for being presents today. It is very important. Let me be clear you handle the operations covering both u. S. Border patrol and customs and Border Protection. Just Border Patrol. Let me for the record take note of the fact that a number of children that died in 2018 but in fact no child had died in custody for the entire decade for 2018 and in particular a number of children that preceded to get medical care and were detained ultimately for my grandchildren have passed away while in or shortly after being released from custody. Whether you have children or not or are around children or relatives acknowledged that the death of a child is a crisis and tragic. Im a father and grandfather and it is a tragedy. The death of any child is devastating but i think its important to not only that its not just devastating to the parents but also in our facility in orangeburg i went and saw our personnel that tried to save despite their best efforts dying in the custody of individuals that are basically lawenforcement but seeing when they are basically committed to has that been your opinion . The death of any child from any person is tragic and as you know, ball and force officers across the country take very seriously the responsibility we place our handcuffs on someone we know we have an ethical, legal and moral duty to care for them as well. I assume this or hastings to agree with that as well it is tragic and on the brink of a crisis. It is a crisis, yes. The idea of those i have been in suing the efforts during very difficult times buying diapers, giving formula, that should be put on the record. But i think the key point, and i appreciate some of the steps that the congressman has made. We traveled together to the border and several times thereafter. My question would be is it time now to prevent reports pursuant to stand up a very effective parallel medical system based on the present policy of this administration meaning asylum is being denied not being able to access it in the way that it should. Parallel to the lawenforcement systems that can do additional things with the records being done in other aspects of reporting and effective almost semiqualified Health Center for these individuals that are coming in. I think that we have to be very cautious we congratulate a facility with Law Enforcement. We firmly believe dhs and it is my personal Belief Health care is best provided in a healthcare setting. What we ought to continue to do this facilitate the movement of people through our system to the best place to care for them, for children bu that is that hhs and custody but we have to continue to harden the system for the times that we face Unprecedented Demand for care and i believe that is exactly what we are doing right now. Me i just have a quick followup, doctor hastings, mr. Hastings come in your point on this system. I would agree completely. We want the Border Patrol to see [inaudible] not out of custody as soon as possible if we have challenges now in the system i set up so we will put that aside. There should be some process that is more substantial that can do Immediate Care besides putting someone in a police car and trying to rush them to the nearest hospital. The question is do we have an effective Emergency Response on site that can deal with sothebys such as a 16yearold found nonresponsive and not much to deal with his nonresponsiveness considerately. To answer the question we are going in the right direction. As i alluded to earlier, we went from three sectors covered by the ethical support personnel to know mine and our busiest locations its where we need them and we will continue to do so on top of that we have got 1500 that can provide support and to provide support and i believe we are takin taking alle right steps that we need to. Our strategy is to provide the right care to the right person at the right time, and i believe we are taking the right steps correctly to do that. We reserve the right to reassess as continues things change but its our belief. The chair recognizes the gentle lady from texas. Thank you for your vote and thank you to the witnesses. Ive been calling on this issue for a great number of years beginning with the first influx when i was the chair of the Senate Caucus in texas and visited probably about ten facilities under the jurisdiction. I seeid seen the differences ia lot of the medical protocols and medical care that is provided in the different facilities. I must say that ive never found them to be adequate. Ive never found them to be a clinic or a hospital and to just borrow the words of my colleague to the right, congressman lee, no one is asking for a hospital. I dont think we are asking for that either, but i think that what we do want is the right to screening to make sure that we get on it as quickly as possible. I was completely stunned at the lack of any kind of screening that was done in the new mexico facility and my colleague talked about the one in her district. It definitely took a microwave coffee table to let her lay there because there was nowhere else to put her. And they were waiting to get the transportation and the bus to go to the facility where perhaps she could get for treatment and then of course she ended up going to the hospital. Are you telling me that under todays particle that has not changed . I am telling you that we do the absolute best that we can under the circumstances we are provided into my opening statement, i told this committee that when we were faced with Unprecedented Demand for care they wanted to remove a microwave to just put her on the table . They will have a screening method so that they can detect it sooner to get her on the facilities that we put in place and many o in many of thes including el paso that has a soft side seemed to have a modular facility as well give us increased capability and increased space that we need, but still many of our stations in many of our different locations have been changed. They will vote for a different demographic. They are in the way of good Healthcare Products and those type of things, but they were not built to house long periods of time alone. Bus system that is in place today by virtue of the growth and the hard work of a lot of people across the government and cbp bears little resemblance to what it looks like at christmas time in 2018. But asking specifically about some of these conversations because many people are using that as a port of entry they frankly arent even allowed to get close enough to make entry the typical flu symptoms would that person be put on the same microwave table . First of all, the expansion of the contracted healthcare allows the Border Patrol to use 1500 in the role they were designed which is to be screening personnel to be outside of the field with anyone else they encounter. The second thing is there therw contracted support and multiple cases to take for the record to get back the exact details of where the contract exists today. So along the entire border of texas, there is some screening particles to ensure that this would never happen again . We have an approach that i described earlier in the heari hearing. Ii am hearing that there is a lot of people on the other side of the border that have been turned away under this new program that have been very, very sick. The care that occurs south of the united its southern border is outside my scope and im not sure what is being done on the mexican side. I will add the logo for medical clearance prior to us returning them so they will go through the same process prior to being returned under the mpp. Additionally there is a map of their outlines where we are today as far as the 40 different locations that we have contract medical service. I realize over 300 individuals at any given time provided that the shuttle will support in the field. You are telling me that although they are being turned away to go back to mexic to mext they do screen than . Can i take that one . The approach to the interview and the assessment applies to everyone in the custody with the parameters that we discussed. But youre turning them away. If they are in our custody, they get the care, the assessments that were described. As i said, the witnesses not understanding the question. Im talking about those that are being turned away in the mexico program. The opportunity to ask that again. Do you have any additional questions . Asking unanimous consent to submit to the Homeland Security Advisory Council final report by the cbp families and care panel would you like to clarify the medical screening that all human beings across the border and coming to the custody with regards to the programs that and intersubjectivity should clarify that for my colleague and for the rest of the Committee Backs it could that is correct. Anyone that comes into the facility regardless of what program they are going into and will go through that medical screening. We still have to process them. If the screening determines that they are sick, to the extent that they need professional medical attention, we are giving them medical attention before we send them back to mexico. As evidenced by the 26,000 we took to the hospital. And that is a policy across the border only one location . Thank you for clarifying that. In your testimony, you mentioned the working relationship between cbp and the office of the dhs chief medical officer. Can you go to the specialized nature of the teams assistance to cross the Border Patrol and also based upo on your observats on how committed is the leadership and expeditiously address medical capabilities . The relationship really is handinhand. Our office and the Border Patrol cbp communicate constantly impact the medical advisers and employees from the office have been embedded into the cbp to help facilitate these issues. The relationship goes handinhand anis handinhandat multiple levels probably it is safe to say daily. With response to the second question, my direction has been clear from every leader in the apartment, whether thadepartmens were cbp the direction i was given, what about the direction of you received all the way to the top . Its been clear and unanimous. They are committed to addressing custody for medical capabilities. I havent spoken directly to victims from the secretary and commissioners ive worked with and its been clear, loud and unanimous do the right thing and take care of the people in our custody. And its been pushed throughout the chain of command . Its been loud and clear from everyone ive worked with. Thank you for the second round of questions i will yield back. Thank you mr. Ranking member i now recognize the gentleman from illinois. I have a couple of followup questions based on what weve heard it today and submitted in the testimony. On page six, im just going to read a couple o of statements. It ensures the cbp will sustain and enhance the go support capabilities with an emphasis on the children less than 18yearsold entities including an interview upon arrival of the facility. Can you further delineate whether those include all Border Patrol stations . It does include all border posting should come against them. To circle back on what was just recently discussed if it includes the Border Patrol station for individuals that are brought into a prevention with the idea that they will be put into this policy you consider that under u. S. Custody, correct . Those individual will get a Health Interview and if those individuals are seen as having some kind of medical wag di to a casual term than they will get a medical assessment. That is correct. Can you confirm that that is happening in all of the facilitys . In the locations where we dont have contract medical support, we utilize local resources to get the assessments. If the interview occurs in folks need healthcare you are saying that they are getting both an interview and screaming into this other local facility they dont have the medical staff on site to the screening you are sending them externally to get that medical completed . Is because the medical need they will certainly utilize the system. So, my thought is on page four keys is currently there are approximately 300 contracts with medical professionals engaged in more than 40 facilities along the southwest border providing 24 7 support and its now available as online southwest border usb key sectors and field offices. So, based on that, would you consider there to be 100 coverage . As i mentioned earlier, we believe that we have about ten more locations of many to cover that are working rapidly to get coverage now and we determine where this went in the population. Its the highest rate that we have seen. We have about ten more locations we are looking to expand to now. We have the current funding to support that, yes. The numbers that are submitted in the testimony or printoutprintouts of what they . These individuals and locations are staffed. The end of december, 2019. Thank you madam chair. I will yield back. Where are the ten additional locations . I would have to look at the chart. I dont have the chart in front of me. I recognize the gentleman from texas. Just a quick followup. What is the average stay for a child in custody . It very is that on average the average time right now is approximately 39 hours the last time i looked. At the last timthe last time i s maam. It is quick since responding. News i dont know the age of your children, but would you be comfortable with having your grandchild in custody in one of your own facilities were 39 hours. Sumac i wanted children and my facilities for that long. Twomac going to be comfortable. It. In a crisis, but for right now for 39 hours, i trust that our employees are taking good care of the detainees that they are charged with. Sumac scene become double if your grandchild was there printed. I think were providing and doing very well promoting Proper Services for all those in our custody right now. During the crisis, no. Would it. I dont want my granddaughter in custody anywhere but i think were doing the best we cant with everything we have out there on the border right now. With all the improvements that we have made. And how quickly we are getting these in the company and alien children out of our custody. What about you doctor eastman. I know you mentioned you have children. Our grandchildren, little nieces and nephews like i do. Would you feel comfortable with member of your family being in custody. , little young for grandchildren but i will tell you that i understand maam, i want to be clear. It would be my preference that we dont ever hold children in our custody. Thats a preference. Again, however, let me be clear from my perspective as a position that we provide or care here irrespective of service as it does not matter to us when they have or have not done. Our care is provided to every human being in our custody. The same no matter what the circumstances are. To answered your question maam, i would be very very countable with my children perceiving care in the system if it were necessary. And i know that were going to continue to do everything we cant to improve it every day. Will be fall out on my calling, questions. He was asking about volunteer doctors. I know that, i am from houston and we have a large Medical Center which we do have a lot of doctors around many of them do a lot of good and a lot of volunteer work in a number of areas we do missions abroad. They have mentioned to me that they have tried to help. They have tried to volunteer and try to even bring especially the flu back to some facilities here printed what about the excess facilities are texas doctors, who are willing to help, why wouldnt we allow them to help. Sumac is declared maam, im a texas dr. As well. The provisions volunteer medical support presents challenges, not just to the department of Homeland Security but to medical organizations in this country in every state. So while we sometimes have difficulty with licensure and administration requirements, we certainly and we have done this, we have tried to victor volunteers who want to provide artist to medical support we are like shelters along this southwest border. So when we had texas volunteers, we try to factor them into the texas ngos that need help. And often times, while that is not my role as dhs senior medical officer, with interest into that because in many ways, when the enemy. Between his medical volunteers for example, your from houston, ive talked to doctor mannix all of us daily. We talk routinely about things like this. One of the things i think that is really important that during the course of this crisis, we have worked with state and local help departments and doctors all across the southwest border. Is that been a handtohand, direct facetoface meetings and working together to solve problems as they arise. We have tried to be the best partner possible to the state and local help departments along southwest border and i think this and if you saw events of that when you came and visited the border and you saw some of those interactions. We will continue to do that. You have my word. We will continue to do his best as possible. What challenges are there. One be anything we cant do in terms of legislation to be able to provide better access to volunteer doctors. My suggestion maam as we take this offline and we were together. The provision of volunteer services and disasters and is volunteer medical services in this country is something that we are interested in. It is the time it outside of the scope of this. But i would love to Work Together with you to try to help solve this problem. Focuses on the same challenges even volunteers who want to help children there and over at our facilities. Even taking them to the movies. Some of these facilities will even allow people to come visit the children. In no way to try to assist in particular your mental help and wellbeing. Well take it offline. We will make it a threeway call. Even though that maam. Thank you. Let me just say that i cant speak for my good friend mr. Higgins, Ranking Member. I think mr. Hastings and doctor ethan for coming today. There are people in positions above you, who dont show up. I dont recall. It is their duty, so you to shut up and you took difficult questions. I am grateful. You could they did. We are well within our constitutional obligation and having a role in oversight. When i think the writing member on the subcommittee because weve been trying to address this issue before anyone is the republican, democrat, black or white or male or woman. We are all human beings. And were all americans. And i know that i cant speak for everyone instrument survey instrument evening when death, and custody is the tragedy. And doctor eason, remember meeting you before you got this position because one of the issues we try to address is how quickly we cant bring qualified people like you, and to help solve this problem. I want to thank you and i know that you have contact with my colleagues as medical background and you might help us all address these tragedies and ensure that they dont happen again. These are children. Theyre being brought here for a better life. Thats all any of this month. And i think the witnesses for their testimonies. The subcommittee may have additional questions. We also that they respond as expeditiously as best as possible. This should be kept open as for ten days. [background sounds] [background sounds] [background sounds] [background sounds]