A 5-Year-Old Girl in Immigrant Detention Nearly Died of an Untreated Ruptured Appendix

A 5-year-old girl fell gravely ill while in Border Patrol custody in McAllen, Texas. Her mother repeatedly sought medical care before her appendix ruptured.

In this photo taken on Sunday, June 17, 2018 provided by U.S. Customs and Border Protection, people who've been taken into custody related to cases of illegal entry into the United States, sit in one of the cages at a facility in McAllen, Texas. As NATO allies convene, one issue not on their formal agenda but never far from their thoughts is immigration, even though illegal border crossings are decreasing on both sides of the Atlantic. The separation of families at the U.S.-Mexico border and Italy’s refusal to let shipwrecked migrants disembark in its ports illustrate the hardening positions on border control in Washington and European capitals. (U.S. Customs and Border Protection's Rio Grande Valley Sector via AP)
In this photo taken on June 17, 2018 and provided by U.S. Customs and Border Protection, people who've been taken into custody sit in one of the cages at a facility in McAllen, Texas. Photo: U.S. Customs and Border Protection's Rio Grande Valley Sector via AP

The death of a Guatemalan child soon after leaving immigration detention made national news this week amid speculation that conditions in detention were responsible for her demise. It is not clear why 19-month-old Mariee Juárez became fatally ill, or if she suffered medical neglect at the South Texas Residential Center, the family detention center better known as “Dilley.” Her family alleges that Mariee became ill due to unsafe conditions and died as a result of medical neglect.

At a different South Texas detention center, another young Guatemalan child recently came down with a common illness that is easy to identify in its early stages but which can kill if not diagnosed and treated. Treatment was delayed for days, however, and the delay put the little girl’s life at risk. And less than three months before that little girl became sick, a Honduran man who spent time at the same facility died from a life-threatening illness that was not diagnosed.

The child and the man were locked up at the infamous Border Patrol detention center in McAllen, Texas, where immigrants are kept for a few days before they are transported to long-term detention centers run by Immigration and Customs Enforcement. The McAllen center is notorious for putting detainees in cage-like rooms and, during the recent “zero tolerance” period, for separating parents from their children. Immigrants know it as “the icebox” and “the dog pound.”

A one-page transport request form in the child’s case was generated by the government and sent to a hospital that later treated her, so the document ended up in her hospital records. It indicates that medical care at the McAllen facility is provided by the Division of Immigration Health Services, which is part of  the U.S. Public Health Service. DIHS supplies medical staff to many long-term immigration detention facilities, including Dilley. Many ICE detention centers have been investigated for medical negligence over the past decade. But there has been little discussion of similar problems in short-term detention centers such as the one where the Honduran man died and the little girl was put at risk of death.

The Intercept attempted to obtain records of the child’s medical history while she was held at the McAllen detention facility, but was told by Customs and Border Protection and ICE that the records are obtainable only through a Freedom of Information Act request. The following account of the little girl’s medical ordeal was provided by her mother.

The Intercept will refer to the mother as Ingrid and to the child as Paulina, in order to protect the family from U.S. government reprisals and from people in Guatemala who want to hurt them.

A Determined Mother

Ingrid has three children who were 3, 5, and 8 years old when they left Guatemala in July to escape attacks against Ingrid by her severely abusive husband. She had money for only two bus tickets, so the family took turns sleeping in bus seats and on the floor. The arduous trip took almost three weeks. Even so, when they arrived in Texas in early August, everyone seemed healthy, including 5-year-old Paulina.

After they were arrested near the Rio Grande by the Border Patrol, the family was transported to the “icebox” in McAllen. It was Saturday, around noon, Ingrid remembered. They were fed half-frozen ham sandwiches on white bread, which the children found distasteful. Paulina took a bite and refused to eat more. A few hours later, she said she felt nauseous. Ingrid chalked it up to the sandwich.

But the next morning, on Sunday, Paulina’s cheeks were flushed. She had a fever, was crying, and said her whole body hurt. Ingrid asked for medical attention, and someone dressed like a doctor gave Paulina a liquid medicine and said that she felt ill simply because she was acclimating to the cold temperature inside the facility. Ingrid was told that Paulina should eat and drink water.

Two hours later, Paulina began complaining of pain in her lower right abdomen and below her belly button. By evening, Ingrid was concerned and again took Paulina for medical attention. The little girl still had abdominal pain and a fever, but the medical staffer did not lay her down on an examining table or palpate the site of the pain. Instead, Paulina got a visual evaluation while she was sitting up and clothed. Ingrid was again advised to have her daughter “drink liquids.” Paulina went back to her cell and fell asleep.

By Monday morning, she had been sick for over 40 hours and was getting worse. She was crying and saying that she needed to pee but couldn’t get to the bathroom because moving her body was too painful. Ingrid carried her, but sitting on the toilet proved so painful that the little girl could not position herself. She urinated on her clothes.

Horrified, Ingrid took Paulina once again to the medical office. Again, the staff failed to lay her down and check her abdomen. They merely took her temperature and gave her medication for fever.

For the next 23 hours, Paulina mostly slept. On Tuesday morning, she awoke and said the pain was so bad that she couldn’t breathe. Ingrid approached the  guards and once again requested medical attention. In seeming disgust, a guard asked, “Now what?” Again, Paulina was not given an abdominal exam.

On Tuesday afternoon, Ingrid was told that the family was being released and would be taking a days-long bus trip to the East Coast to join a friend whom Ingrid had designated as the family’s U.S. sponsor. Ingrid could not imagine Paulina traveling in the shape she was in, but the family was put in a line with others who were being readied for transport to the bus station in McAllen. Ingrid was desperate for another medical visit for Paulina, but she was afraid the guards would again get angry if she requested one. She asked to go to the bathroom, even though her true destination was the clinic. She snuck off with Paulina in her arms.

It was now over 70 hours since Paulina had first started to feel sick, and 50 hours after she’d started complaining of abdominal pain on her lower right side. For the first time, the medical staffer laid the child down and touched her belly. The staffer then told Ingrid that medicine was being ordered for Paulina but it wouldn’t arrive for two hours. It was about 3 p.m.

By 9 p.m., the medicine still hadn’t come, and Paulina said she could no longer stand the pain. While she was talking about this to Ingrid, she suddenly passed out. Finally, a medical staffer called for an ambulance.

Paulina came into the emergency room with a fever of 103.1 degrees, serious dehydration, a pulse of 170, and abdominal pain, according to medical records. She was quickly diagnosed with a ruptured appendix and peritonitis — a potentially fatal inflammation of the tissues around the organs, caused by bacteria leaking from the appendix. Within hours, she was given an appendectomy. She received large doses of intravenous antibiotics to counteract the peritonitis, and a tube was inserted into her belly to drain the infected fluid.

“Beyond Words”

The Intercept provided Dr. Dolly Sevier, a pediatrician who practices in South Texas, with Ingrid’s chronology of Paulina’s illness while in CBP detention. Sevier also reviewed records The Intercept obtained of Paulina’s treatment in the emergency room.

Based on that information, Sevier called CBP’s medical care of Paulina “negligent.” According to her mother’s chronology, Sevier said, the little girl should have been sent to an emergency room early on Sunday, less than a day after being put into Border Patrol detention, if only because medical staff there had already noted then that the little girl was dehydrated.

Sevier said that if Paulina had been properly examined, appendicitis would have been suspected by Sunday afternoon. When an infected appendix is untreated over days, it ruptures, creating the possibility of massive internal infection that can lead to death. Sevier theorizes that Paulina’s appendix ruptured on Tuesday night, which would explain why she lost consciousness. That was 2 1/2 days after she should have first been sent to an emergency room. If Ingrid’s account is accurate, Sevier said, CBP’s negligence is “beyond words.”

Thanks to her mother’s persistence, Paulina’s appendicitis was caught and treated in time, and today she is healthy. Ronal Francisco Romero was not so lucky. The 39-year-old Honduran was apprehended by Border Patrol on May 9 while crossing into the U.S. illegally. He was taken to the agency’s processing facility in McAllen and stayed there for five days, until May 14. Then he was transferred to a nearby ICE detention center in Los Fresnos, Texas. Within a few hours of arriving there, medical staff had him transported to a nearby hospital. He was put into intensive care and died hours later.


Ronal Francisco Romero died of bacterial meningitis after being in Border Patrol custody for five days in McAllen, Texas.

Photo: Courtesy of the family/Andrew Free

Romero’s body has since undergone two autopsies. The Intercept obtained the second one, which notes that it agrees with the first autopsy’s finding of bacterial meningitis, a deadly infection of the brain, as the cause of death. In Romero’s case, the meningitis began with otitis media — a middle ear infection.

Romero’s mother is suing the government for negligence. According to filings by her lawyer, Andrew Free, Romero probably experienced an “agonizingly slow and excruciatingly painful death” after spending several days “intensely, visibly ill and in severe pain” in detention in McAllen. Among the signs and behaviors that fellow detainees and medical staff would have noticed, according to Free, are clamminess, discolored skin, fever, dehydration, and vomiting. It’s also likely that Romero appeared increasingly disoriented and confused. His suffering would have been immediately obvious, Free said. In fact, most people with middle ear infections that can develop into meningitis survive because they hurt so badly. The intense pain of the earache prompts them to seek care before things get bad enough to cause shock, organ failure, and death.

Free believes Romero’s illness was ignored in the McAllen detention center. He is currently trying to locate and interview staff or fellow detainees who saw Romero while he was detained. Free is also trying to get an ICE death review of the case. Such reviews are done for every person who dies or becomes fatally ill while in ICE detention, and they are supposed to be completed within 30 days after the death. Romero died on May 19, but Free has not received the death review. The Intercept requested a copy from the agency’s media department and was told to file a Freedom of Information Act request.

The Intercept contacted the U.S. Public Health Service and CBP and asked for responses to Paulina’s mother’s description of the child’s medical crisis while detained; as well as their reaction to the information in Paulina’s hospital records and to Dr. Sevier’s characterization of the little girl’s medical care in detention as negligent. We also asked for responses to the autopsy of Ronal Romero. CBP did not respond, and the U.S. Public Health Service declined to comment.

A History of Negligence

Romero’s death immediately following his stay in McAllen, and Paulina’s brush with death in the same facility, illustrate long-standing problems with medical care in immigration detention.

DIHS provides health care to detainees at about half of all immigrant detention facilities. Contract employees provide care at others. The transport document in Paulina’s hospital records indicates that the McAllen facility uses DIHS for health care.

A decade ago, the Washington Post investigated deaths of immigrants held in many such facilities and concluded that the access of these deceased to medical care had been “slow,” “shabby,” and even utterly lacking. From 2003 to 2008, the Post noted, 83 detainees died in or soon after custody — and of those deaths, more than a third might have been at least partially caused by actions taken or not taken by medical staff. Two years later, in 2010, the New York Times found similar problems.

In 2016, the American Civil Liberties Union, Detention Watch Network, and the National Immigrant Justice Center published the findings of a joint investigation into government reviews of deaths from January 2010 through May 2012. The researchers asked ICE for 24 death reviews; ICE responded with documentation for 17. Of those, it turned out, ICE had determined that noncompliance with its own medical standards contributed to or even caused eight deaths — almost half of the total.

Human Rights Watch has continued to analyze ICE detention death review cases and found the same problems as in earlier years — except they seem to be getting more prevalent. In fiscal year 2017, more people died in immigration detention than in any year since 2009.

Things may be even worse in the Border Patrol’s short-term detention facilities, such as the one in McAllen. During the 2016 investigation of ICE death reviews, ICE told the investigators that reviews are not performed when someone dies in a short-term holding facility. ICE’s response, as the investigators put it, raises the question of “whether such gaps in responsibility are endangering other lives.”

Today, almost four weeks after her surgery, Paulina is recuperating nicely and playing again with her siblings at a church-sponsored shelter in South Texas. Ingrid is waiting for a doctor to clear her daughter for travel so that the family can finally make their trip to the East Coast.

As Ingrid made plans for a new, safer life in the U.S., she remembered the early morning hours in the emergency room when she sat waiting to find out what was wrong with her gravely ill child. A hospital staffer approached and told her, in Spanish, that Paulina had just been diagnosed with a ruptured appendix.

“Tell me the truth,” Ingrid recalled the staffer berating her. “You must have seen for at least three days that she had something wrong, and it was getting worse. So tell me the truth. Why didn’t you take her to the doctor?”

“I did take her,” Ingrid answered. “I took her and took her. But we were being held by Immigration. And no one there did anything.”

Correction: September 2, 2018

A previous version of this article misspelled the last name of Andrew Free, the attorney representing Ronal Francisco Romero’s mother.

Top photo: In this photo, provided by U.S. Customs and Border Protection, people who’ve been taken into custody sit in one of the cages at a facility in McAllen, Texas, on June 17, 2018.

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