1 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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3 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

4 Service Processing Centers and Contract Detention Facilities that House U.S. Immigration and Customs Enforcement (ICE) Detainees* 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

5 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

6 U.S. Immigration and Customs Enforcement Detainees Active Tuberculosis Cases Reported to Immigration Health Services, by Country and Release Status*, 2005 *Classified as a TB case by treating physician; not verified as meeting CDC criteria for national surveillance Release Status

7 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

8 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

9 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

10 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 electronic information sharing/health record sharing of expertise and resources treatment, medication availability laboratory support adherence contact investigations

11 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.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

12 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

13 Acknowledgements 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 Peredo- Berger 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

14 Acknowledgements 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

15 Contacts and Information Division of Immigration Health Services Diana Schneider, DrPH, MA phone: (202)

16 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

17 ICE Custody Border apprehensions Special Missions Interior Apprehensions Transfer from other law enforcement entities Often poor or no documentation of previously diagnosed medical conditions Intake Screening includes TB screening

18 U.S. Immigration and Customs Enforcement Detainees Active Tuberculosis Cases Reported to the Division of Immigration Health Services*, *Classified as a TB case by treating physician; not verified as meeting CDC criteria for national surveillance