September 11, 2007

Julie L. Myers
Assistant Secretary
U.S. Immigration and Customs Enforcement
Department of Homeland Security
425 Eye Street, NW
Washington, DC 20536

Re: Victoria (a.k.a. Víctor) Arellano [A: 77991267]

Dear Ms. Myers,

We, the undersigned organizations, representing HIV/AIDS, civil rights, human rights, immigrant justice, and civil liberties advocates and service providers from across the United States, write to you today to express our outrage over the July 20, 2007 death of Victoria (a.k.a. Victor) Arellano in the San Pedro detention center. Victoria's death was excruciating and needless. Her requests for her AIDS medication were deliberately and repeatedly denied, as were her fellow detainees' increasingly desperate pleas to staff to take her to the hospital.

When Victoria was sent to San Pedro in May, she was taking the antibiotic dapsone to prevent pulmonary infections from developing into pneumonia. At San Pedro, she was denied the medication despite the known consequences of discontinuing this antibiotic: the onset of treatment-resistant pneumonia within a few weeks. Indeed, Victoria's health deteriorated rapidly to the point where the pain was so great, she would scream if anyone tried to move her. She complained of severe nausea, headaches, cramps, and back pain. She was vomiting and suffering from diarrhea. Her care was left to the men detained with her. They administered cold compresses to bring down her fever and took turns taking her to the bathroom when she was too weak to get there by herself. Seventy of them signed a petition appealing for medical care for Victoria.

A week before her death she was taken to the infirmary and give amoxicillin. Again, the standard of care for people living with AIDS was ignored. Amoxicillin is ineffective against meningitis and AIDS-related lung infections. When Victoria returned from the infirmary, she began vomiting blood. Once again, her fellow detainees put themselves on the line to demand medical attention for Victoria. She was finally taken to a hospital but was returned to the detention center less than 24 hours later. By the time she was taken to another hospital, it was too late. She died shackled to her bed in the ICU. Her mother reports her body was wracked by pneumonia and meningitis.

With everything to lose - with their own futures uncertain - the men detained with Victoria Arellano met the brutality and the calculated negligence of ICE with profound humanity. They cared for her; they advocated for her; they even consoled her mother when she lost her child. Some of these men have been transferred out of San Pedro, possibly to prevent them from participating in an investigation and/or in retaliation for their role in trying to save Victoria.

Although she was born male, Victoria had been living and identifying as a woman for years. It is not appropriate to house women, such as Victoria, in a male dormitory. ICE must revise its policies to ensure that transgender women are placed with other women in female facilities. While we are grateful for the care given to her by the men she was housed with, other transgender women have not been so lucky. It is widely known that they are at increased risk of assault when placed with the male population. In Victoria's case, it was the guards who harassed her. Further, another transgender woman testified at the National Prison Rape Elimination Commission in Los Angeles in December 2006 that she had been raped by an official at San Pedro.

Victoria's was not the only foreseeable, preventable death to have occurred in ICE detention. Hers wasn't even the first in San Pedro. Media reports indicate that since 2004, at least 65 people have died in ICE detention. The guidelines for medical care contained in the Department of Homeland Security's Detention Operations Manual (DOM) are insufficient and unenforceable. Far from providing a recognized standard of care, ICE fails to meet even its own standards of providing "primary medical care, and emergency care." Facilities the size of San Pedro are required to make medical personnel available to see detainees who request medical services in a clinical setting at least five days per week. Victoria, like many others, was not given this access and had to wait much too long before she received any care.

The DOM further states that following a clinical evaluation, if an HIV-positive person in detention "manifests symptoms requiring treatment beyond the facility's capability, the provider will recommend the detainee be transferred to a hospital, or other appropriate facility for further medical testing, final diagnosis, and acute treatment as needed…HIV positive detainees should be hospitalized until any acute treatment deemed necessary is completed."

In response to the glaring violations of current DHS/ICE guidelines and of Victoria Arellano's human rights, we seek the implementation of new policies that meet appropriate standards of care and that are reviewable and transparent to the public.

We, the undersigned organizations, call on the Department of Homeland Security and Immigration and Customs Enforcement to:

• Implement revised standards that are enforceable and legally binding in all ICE/DHS detention facilities, regardless of whether said facilities are operated by the federal government, private companies, or state/county/local agencies. Detainees, their families, and their representatives must have legal recourse when these standards are violated.
• Provide effective internal and external oversight of detention conditions and treatment of detainees. This would include the establishment of an ombudsman, ongoing monitoring and frequent inspections with subsequent reports released to Congress and made available to the public.
• Immediately rectify any and all breaches of detention standards, including denial of medical care.
• Increase the availability of medical personnel to see detained individuals who are in need of care, regardless of whether or not a detainee has made a formal request for care. Currently, facilities with over 200 detainees are only required to schedule "sick calls" five days a week, while facilities with fewer than 50 detainees need only provide access to medical personnel one day a week. This is grossly insufficient.
• Commission an investigation into the death of Victoria Arellano that is independent and transparent, so that the public may have confidence in the investigation's outcome.
• Strengthen the DHS/ICE national detention standards to comply with human rights principles.
• Ensure that treatment regimens, including medication for HIV/AIDS and related infections and hormone therapy for transgender detainees are not interrupted.
• Adhere to international covenants and treaties mandating the humane treatment of all detainees, including the International Covenant on Civil and Political Rights and the Universal Declaration of Human Rights.
• Pursue non-custodial alternatives (e.g., parole, supervised release to family members, regular reporting requirements, bond options) for immigration detainees, particularly for those individuals whose health or personal safety would be imperiled by detention.
• End the practice of prolonged and indefinite detention, which is a violation of both international and U.S. law.
• Publicly report all deaths that occur in ICE custody, refer them immediately to the Office of the Inspector General for investigation, and make the results of each inquiry available to the public as soon as it is complete.
• End the practice of placing immigration detainees with the general inmate population.
• Ensure that the safety of detainees, particularly transgender detainees is the paramount consideration when deciding whether to place an individual with the male or female population. Solitary confinement must not be considered a viable option.
• Grant transgender detainees the right to choose to be housed in a facility that corresponds with their gender identity, regardless of which sex is listed on their legal documents and/or regardless of their birth-sex.
• Revise the DOM to address the particular needs of gay men, lesbians, bisexuals, and transgender men and women, including health and safety issues.
• Train all staff in all facilities where ICE detainees are held to comply with these standards and safeguard the inherent dignity of all persons.

We are bringing this matter to the attention of our elected officials and we urge you to take prompt and necessary action to prevent further threats to health and loss of life among immigrants in ICE detention.

Sincerely,

cc:   Secretary Michael Chertoff Director John P. Torres Dr. Timothy T. Shack Ambassador Mark Dybul Warden Rudolph Garcia Senate Majority Leader Harry Reid Speaker Nancy Pelosi Senator Barbara Boxer Senator Hilary Clinton Senator Diane Feinstein Senator Patrick Leahy Senator Joseph Lieberman Senator Charles Schumer Representative Tammy Baldwin Representative Xavier Becerra Representative Howard Berman

Representative John Conyers, Jr. Representative Barney Frank Representative Charlie Gonzalez Representative Raul Grijalva Representative Luis Gutierrez Representative Barbara Lee Representative Zoe Lofgren Representative Jerry Nadler Representative Ileana Ros-Lehtinen Representative Lucille Royball-Allard Representative Linda Sanchez Representative Hilda Solis, Representative Bennie G. Thompson Representative Nydia Velázquez Representative Maxine Waters Representative Henry Waxman