Transcript Post-Detention Continuity of TB Therapy for the Bureau

Continuity of TB Therapy for U.S. Immigration
and Customs Enforcement (ICE) Detainees
An Update
Advisory Council for the Elimination of Tuberculosis
March 20, 2007
Diana Schneider, DrPH, MA
CDR, US Public Health Service
U.S. Department of Health and Human Services
Health Resources and Services Administration
Bureau of Primary Health Care
Division of Immigration Health Services
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ICE Custody
• ICE detention is to facilitate removal
• Criminal charges resolved before admission to
ICE custody
• ICE must remove individual as soon as possible
following Final Order of Removal
• Must remove within 90 days by statute
• Post Order Custody Review if removal cannot be
accomplished within 180 days
• If otherwise can be deported, cannot keep people
in custody because of illness
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Service Processing Centers and Contract Detention Facilities that House
U.S. Immigration and Customs Enforcement (ICE) Detainees*
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ICE Service Processing Center and ICE Staging Facility, DIHS staffing,
digital radiography screening
ICE Service Processing Center, DIHS staffing, TST screening
Contract Detention Facility or IGSA, DIHS staffing, digital radiography screening
Contract Detention Facility or IGSA, DIHS staffing, TST screening
Contract Detention Facility or IGSA, Contractor staffing, TST screening
* Locations without symbols have ICE detainees housed in local jails nationwide
TB among ICE Detainees
• Intake Medical Screening/TB Screening
– Infection control
– Maintain a safe detention and working environment
– Case detection
– Continue or initiate treatment as indicated
• Detainees with active TB often deported prior to
completion of treatment
• ICE does not deport patients while contagious
• Patients often deported before culture results are
available
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U.S. Immigration and Customs Enforcement Detainees Active Tuberculosis Cases
Reported to Immigration Health Services, by Country and Release Status*, 2005
70
60
50
Count
Release Status
40
missing
RELEASED IN U.S.
REMOVED
30
20
10
AM
VI
ET
N
PE
RU
SU
DA
N
EX
IC
NI
O
CA
RA
G
U
A
AS
M
UR
ND
HA
IT
I
EL
HO
UA
DO
SA
R
LV
AD
O
R
ER
IT
RE
G
UA
A
TE
M
AL
A
BA
EC
CU
A
IN
CH
BR
AZ
IL
0
Country
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*Classified as a TB case by treating physician; not verified as meeting CDC criteria for national surveillance
TB Continuity of Care Processes
• Notification to DIHS Epidemiology Unit
• Short-term medical holds
• Referral for treatment and case management
– TBNet Program
– CureTB Program
• Binational TB Card
• Coordinated Removal / Medical “meet and greet”
• Requests for stays of removal
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Stays of Removal
• Stays of removal may be considered
– MDR, medically complicated, nonadherence,
concomitant mental health conditions,
frequent border crossers
– Do not ensure continued custody
– ICE may require other secure environment
• (U.S.) State and local jurisdictions have authority to
compel isolation and treatment
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Challenges
• Notification before release
• Differing diagnostic and treatment norms U.S. vs. other
• Adherence
• Authorities to compel isolation and treatment are unclear
• Information-sharing across jurisdictional boundaries
• If stays of removal are granted, case management may
become health department responsibility
• Department of Homeland Security initiatives
– Secure Border Initiative
– Increasing detention capacity
– Expedited removals
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Workgroup Recommendations (1)
1. Engage the foreign national health authorities and
the U.S.-Mexico Border Health Commission to:
a. Establish mechanisms to foster binational and
international collaborations regarding TB case
management, including
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electronic information sharing/health record
sharing of expertise and resources
treatment, medication availability
laboratory support
adherence
contact investigations
Workgroup Recommendations (2)
b. Convene a public health legal forum to better
facilitate binational/international case management
c. Engage the foreign National TB Programs to
promote collaboration with coordinated removals /
TB meet and greets
2.
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Recommend to CDC that a mechanism be
established to count all TB cases that are managed
by state and local TB control programs for
determining federal funding
Next Steps
• Evaluation initiated
– Assess outcomes
– Stakeholder interviews
• Continue education and outreach
– State and regional TB meetings
– NTCA breakout session
– Planning webinar with Southeast Regional TB
Training and Medical Consultation Center
– Educational materials
• Workgroup conference calls
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Acknowledgements
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DIHS Staff:
Aguadilla, PR: CDR Karen Dorse, CDR Wanda Gonzalez
Batavia, NY: CDR Jeri McGinnis, LT Deborah Doody, Dr. Brenda Bailey
El Centro, CA:, LCDR Eileen Falzini, LCDR Upeng Demske, Dr. Carlos Duchesne
El Paso, TX : LCDR Erik Hierholzer, LCDR Zita Guerrero, Dr. Rosa Colon, LCDR Chiara
Rodriguez
Elizabeth, NJ:, LCDR Rusty Waldron, LT Jonee Mearns, LT Raymond de la Peña, Dr.
Chang Park
Eloy, AZ: LCDR Melissa George
Florence, AZ: CDR Claire Karlson, Dr. Elizabeth Fleming, LT Marc Winoker
Harlingen, TX: LCDR William Rekward
Houston, TX: CAPT Christine Williams, LT, Monique Frazier, LT Cynthia Beard
Los Angeles, CA: LCDR Jason Ortiz, LTJG Katherine Maye
Miami, FL: CDR Kirsten Warwar, CDR Jaime Muñiz, Dr. Abelardo Montalvo, LCDR Andrew
Ganzon
Pearsall, TX: CAPT BuJean Jenkins, Dr. Erik Johnson, LCDR Gina Chacon
Port Isabel, TX: CAPT Marian Moe, LT Maria Morel, CDR Adolfo Zorilla, Dr. Luz PeredoBerger
San Diego, CA: LCDR Steve Gonsalves, Dr. Ester Hui, LCDR Bonnie Saylor
San Pedro, CA: LCDR Chris Henneford, LT Shelly Hollandsworth
Stewart, GA: CDR Lynn Harris, CDR Sherlene Jacques, CDR Betty Shaw
Tacoma, WA: LCDR Deanna Gephart, LT Christine Chang, Dr. Phil Farabaugh
Taylor, TX: LCDR Tom Hochberg, CDR Peggy Mathis, LCDR Angel LaSanta
Willacy, TX: CDR Dawn Anderson-Gary
Headquarters: Mr. Neil Sampson, Dr. Tim Shack, LCDR Alice Fike, Ms. Jennifer Cheng
Acknowledgements
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ICE/DHS: Jay Brooks; Joan Lieberman; Tim Perry, Nina Dozoretz
CDC: Ken Castro, Mark Lobato, Kayla Laserson, Stephen Waterman, Maureen Wilce,
Miguel Escobedo, Steve Harris, Todd Wilson, Steve Benoit, Bill MacKenzie
DHHS/OGC: Jocelyn Mendelsohn
Arizona Dept. of Health Services: Karen Lewis, Angelito Bravo, Patty Gast, Ayesha Bashir
Arizona Attorney General’s Office: Kevin Ray, Don Schmidt
CA Dept. of Health Services: Sarah Royce, Anne Cass, Stephanie Spencer
Colorado Department of Health: Barb Stone, Gayle Schack
Denver TB Control: Randall Reves
Florida Dept. of Health: Halsey Rhodes, Toni Johns
Georgia Department of Human Resources: Beverly Devoe-Payton, Karen Buford
New Mexico: Gary Simpson, Cliff Rees
TX Dept. of State Health Services: Charles Wallace, Phyllis Cruise, Sandra Morris, Mike
Greenburg, Walter Erhesman, Jose Moreira, Maria Rodriguez
San Diego County Health Dept/CureTB: Kathy Moser, Alberto Colorado, Florencia
Sisterson, Francisco Velasco, Rafael Garcia
Migrant Clinicians Network: Jeanne Laswell, Del Garcia, Ed Zuroweste, Bertha
Armendariz, Nora Martinez, Karen Mountain
Public Health Institute (CA): Samantha Graff
Pan American Health Organization: Kam Suan Mung, Guillermo Mendoza, Mirtha del
Granado
U.S.-Mexico Border Health Commission: Dan Reyna
National TB Programs: El Salvador, Guatemala, Honduras, Nicaragua
Contacts and Information
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•
Division of Immigration Health Services
Diana Schneider, DrPH, MA
phone: (202) 732-0070
e-mail: [email protected]
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www.ice.gov
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www.dhs.gov/immigrationstatistics
Objectives
• Provide background on the DIHS/ICE TB
Continuity of Care Program
• Provide an update on TB continuity of care
activities for U.S. Immigration and
Customs Enforcement detainees
• Present workgroup recommendations
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Border
apprehensions
Special Missions
Interior Apprehensions
Transfer from other
law enforcement
entities
Often poor or no documentation of previously
diagnosed medical conditions
ICE Custody
Intake Screening
includes TB screening
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U.S. Immigration and Customs Enforcement Detainees
Active Tuberculosis Cases Reported to the Division of Immigration Health Services*, 2001-2005
160
142
140
120
Count
100
77
80
72
58
60
41
40
20
0
CY2001
CY2002
CY2003
CY2004
CY2005
Reported Active TB
Year
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*Classified as a TB case by treating physician; not verified as meeting CDC criteria for national surveillance