The story of one immigrant who didn’t survive detention

Francisco Castañeda came to the United States from El Salvador when he was ten. It was 1983. His father had just died of a heart attack, and his country was in the midst of a civil war. His mother packed up their belongings, crossed the border illegally with her four young children, and settled in an apartment complex in Southern California. The family never went back.

Castañeda, known by his middle name, Alex, grew up in L.A. He then worked in construction and had a daughter, Vanessa. He also got involved in drugs. In late 2005 and early 2006, he spent four months in prison for possession of methamphetamines. From there, Immigration and Customs Enforcement (ICE) took him into custody in its San Diego facility.

Castañeda had a painful lesion on his penis and he immediately asked to see a doctor about it. Within a few days, a doctor examined him and said he needed to see a specialist.

“But instead of sending me directly to a specialist, I was forced to wait, and wait, and wait,” Castañeda testified at a Congressional hearing last October 4. “All the while, my pain got worse. It started to bleed even more and smell really bad.”

More than a month passed, and Castañeda saw an oncologist, who was worried that he had cancer and told him he needed a biopsy.

“I tried to get medical help every day,” he testified. “Sometimes, I would show the guards my underwear with blood in it to get them to take me to medical, but then they would say they couldn’t do anything for me. All they gave me was Motrin and other pain pills. At one point, the doctor gave me special permission to have more clean underwear and bedsheets because I was getting blood on everything. A guard from my unit once told me he would pray for me because he could see how much I was suffering.”

When he became fearful and upset, they gave him sleeping pills and considered referring him to a psychologist. The Division of Immigration Health Services (DIHS), a part of ICE, deemed this treatment “necessary, appropriate, and in accordance with our policies” and declared a biopsy “not urgent.”

Through the summer and fall of 2006, Castañeda petitioned DIHS to give him a biopsy. Again and again, it refused. In a classic example of doublespeak, DIHS wrote that he “DOES NOT have cancer at this time due to not having a biopsy performed.” When describing the biopsy that two outside doctors had ordered, DIHS employees inserted the word “elective” into their reports, which neither doctor used. At one point, he was even taken to the emergency room at Harbor-UCLA Medical Center for a biopsy, but after an hour the guard took him back without being seen.

In November 2006, after months of filing complaints, Castañeda was transferred from San Diego to the San Pedro facility and forced to leave behind all his possessions, including his legal and medical papers.

Finally, DIHS scheduled a biopsy, but rather than pay for the surgery, ICE released him and canceled the appointment.

Upon his release on February 5, 2007, Castañeda returned to the Harbor-UCLA Medical Center and got his biopsy. He was diagnosed with invasive squamous cell carcinoma of the penis. His penis was amputated on Valentine’s Day, 2007, and he began chemotherapy, but it soon became apparent that his cancer was terminal. Squamous cell carcinoma is considered treatable if caught early.

“I have a young daughter, Vanessa, who is only fourteen,” he testified. “She is here with me today because she wanted to support me—and because I wanted her to see her father do something for the greater good, so that she will have that memory of me. The thought that her pain—and mine—could have been avoided almost makes this too much to bear.”

He recognized that his time was short. “In many ways, it’s too late for me,” he added. “I had to be here today because I am not the only one who didn’t get the medical care I needed. It was routine for detainees to have to wait weeks or months to get even basic care. Who knows how many tragic endings can be avoided if ICE will only remember that, regardless of why a person is in detention and regardless of where they will end up, they are still human and deserve basic, humane medical care.”
Castañeda died this February 16. At his wake, he was wearing the same suit he wore to testify in Congress.

Before he died, he filed suit against ICE, DIHS, as well as against a number of its employees. On March 11, U.S. District Judge Dean Pregerson refused to dismiss part of the lawsuit that questioned the constitutionality of ICE’s policies. (His family took over the suit after his death.) The records “bespeak of conduct that transcends negligence by miles,” said Judge Pregerson.

Not long after Pregerson’s ruling, the government admitted to negligence in Castañeda’s death. But the family, represented by the nonprofit group Public Justice, refuses to settle the case. It is seeking monetary damages, and it is also demanding a change in immigration policy.

Currently, that policy says detainees have the right to emergency care. This means they will receive treatment if they are at risk for loss of life, limb, hearing, or eyesight. Any other requests must be sent to DIHS in Washington, D.C., for approval.

Public Justice has a strong case. Medical treatment of immigrant detainees—300,000 immigrants were detained in fiscal 2006, and around 30,000 are in detention at any given time—is held to a far lower standard than medical treatment of convicted criminals. For instance, an immigrant detainee with a lump on her breast may wait at least a year before receiving a mammogram—even then, she may receive it only if it’s clear that she will be in custody for the foreseeable future. The same is true for tests for cancer of the cervix, uterus, prostate, and for colorectal cancers. In contrast, government policy states that convicted criminals receive screening for breast and gynecological cancers in a timely fashion. The whole purpose of screening is to catch dangerous diseases early.

Representative Zoe Lofgren, Democrat of California, and Senator Robert Menendez, Democrat of New Jersey, have introduced the Detainee Basic Medical Care Act of 2008. This bill would require Immigration and Customs Enforcement to ensure “timely and effective delivery of medical and mental health care to all immigration detainees in custody.” However, because Lofgren’s bill has only Democratic co-sponsors and was introduced late in the Congressional term, it is unlikely to pass.

Lofgren obtained ICE documents that list some medical procedures it denied detainees. Procedures were denied for HIV, renal failure, pneumonia, asthma, type 2 diabetes, and dehydration. Next to the denials was a column listing the dollars saved. Says Lofgren, “Detention should not be a death sentence.”

Laurel Maury is a reviewer and critic based in New York. She reviews graphic novels for NPR’s online column “Books We Like,” and writes regularly for The Los Angeles Times Book Review.