Substandard medical care of detained immigrant children experiencing common acute illnesses: Evidence from a U.S. family immigration detention facility

Abstract

Access to timely, pediatric-specific medical care is critical for every acutely ill child to prevent complications, long-term disability, and untimely death. This is particularly important in contexts such as immigration detention facilities, which pose unique risks to children. A retrospective observational study was conducted of 165 children who were detained at the Karnes Family Residential Facility from June 2018 to October 2020. Acute care visits completed at the facility were reviewed. Chart notes for three of the top six chief complaints (i.e. cough, fever, and diarrhea) were analyzed for a series of quality measures derived from national clinical guidelines. The analysis revealed significant deviations from clinical standards, including incomplete clinical assessment, a failure to determine a clinical diagnosis, and inappropriate prescribing. These deviations were noted with alarming frequency, suggesting a systemic failure in adherence to standards of care. Detention is never in the best interest of the child and must end. However, as long as immigrant children remain detained in the US, they must receive age-appropriate healthcare that meets quality standards. Critical review, external oversight, and reforms of medical care in immigration detention are essential to ensure that children are protected from the preventable increased morbidity and mortality associated with this setting. Ample research has documented the inadequacy of healthcare in U.S. immigration detention for adults, however empiric data on pediatric care in these facilities remain limited. This study is the first to examine pediatric acute care using primary data from children’s medical records.