Tuberculosisof the lungs

Health care officials within Immigration and Customs Enforcement (ICE) have established more than 50 “airborne infection isolation rooms” at more than a dozen different detention centers across the country to deal with those illegal aliens they suspect may already have – or might soon develop – active tuberculosis.

Each year, ICE confronts approximately 150 to 200 cases of active or suspected tuberculosis nationwide, estimated Commander Diana Schneider, ICE’s branch chief for epidemiology, who spoke with Government Security News in an exclusive phone interview on April 18. That might seem like a small percentage of the 400,000 detainees who revolve through the agency’s detention facilities each year, but Schneider considers the threat posed by the disease to be a significant challenge.

“It’s an important public health issue because case management for tuberculosis patients is complex and treatment takes a long time,” she told GSN.

The airborne infection isolation rooms, which house one detainee at a time, are designed to maintain negative air pressure (to prevent any contagions from escaping the room and infecting other detainees or staff members in the center). the isolation rooms are outfitted with High-Efficiency Particulate Arresting, or HEPA, filters, which are intended to remove the vast majority of particles from the air that passes through them.

Tuberculosis, or TB, is a common, and in many cases lethal, infectious disease that most frequently attacks the lungs. it is typically spread through the air when an infected person coughs, sneezes or spreads his or her saliva. By some estimates, about 10 percent of all tuberculosis infections eventually become active, and, if left untreated, the disease is said to kill more than half of those it infects.

ICE detention facilities are particularly vulnerable to this dangerous disease because the foreign population it detains, processes and, often deports from the U.S. generally has received less preventative health care during their lifetimes than the average American. “They have not had routine, regular medical care in the past,” explained Gillian Christensen, deputy press secretary at ICE, who also participated in the phone interview. “Rates of TB in developing countries are higher than in the U.S.,” Schneider added.

Consequently, all detainees brought into an ICE detention facility are routinely checked for TB, as a mandatory component of their general intake medical screening, said Schneider. This examination may take the form on a chest X-ray, a skin test or a new type of blood test. If health personnel at a center detect active TB, or suspect that the symptoms may soon develop, the detainee is kept in the isolation room until the situation is clarified.

Depending on the outcome of such tests, the detainee might be deemed to be free of TB and moved in with the general population, might be kept in isolation, might be moved to an entirely different medical facility (such as a local hospital) or — if they are considered not contagious — might be deported to their home country. ICE considers these options to be part of its overall “continuity of care” program for “detainees with confirmed or suspected active tuberculosis.”

Nonetheless, a detainee’s status as a legal or illegal alien in the United States is not affected by these medical considerations. “They might be started on treatment for TB,” explained Schneider, “but they would still need to be processed in conformance with immigration laws.”

Put another way, a detainee’s medical condition — even if they have an active case of tuberculosis — is not a factor when they are brought before an immigration judge. “That would not be a consideration by the immigration judge,” said Schneider.

TB might be the primary reason why a detainee would be housed in an airborne infection isolation room at an ICE detention facility, but it is not the only reason. such rooms are occasionally used to house individuals suspected of contracting chicken pox, influenza or measles, though Schneider told GSN, “I don’t recall any measles since I’ve been here.”

ICE recently awarded a $230,000 small business set-aside contract to Air Management Solutions, inc., of Powder Springs, GA, to maintain and certify the status of many of the isolation rooms at ICE detention facilities across the U.S.

If an individual detainee, in fact, has an active case of tuberculosis, but the disease has been brought under control by ICE specialists and is no longer deemed to be contagious, that person may be brought back to his or her home country. Ideally, government authorities, or non-profit charitable organizations in that country will arrange for “meet-and-greet” sessions at the port of entry, and help make arrangements for the individual’s continuing medical care.

This overall ICE initiative, which Schneider considers to be “a model for continuity of care and public health,” is part of a broader set of reforms which DHS Secretary Janet Napolitano and Assistant Secretary for ICE, John Morton, rolled out in October of 2009. the two DHS officials announced at that time that one of their goals was to “enhance detainee medical care” and pledged that ICE “will devise and implement a medical classification system that will improve awareness of an individual detainee’s medical and mental health conditions from the time the individual first enters detention.”