An internal investigation by U.S. Customs and Border Protection (CBP) found Border Patrol medical staff declined to review the file of an 8-year-old migrant girl who died in U.S. custody on May 17, according to a statement released Thursday.
Anadith Tanay Reyes Alvarez, who had a chronic heart condition and sickle cell anemia, died at a hospital in Harlingen, Texas, after entering through Brownsville with her parents and two older siblings on May 9. CBP previously said the child's medical history was shared with authorities the following day on May 10.
The family arrived at Harlingen Station for medical isolation on May 14 after Alvarez was diagnosed with the flu at a temporary holding facility, according to CBP.
During the nearly three days at the location, contracted medical personnel reported nine separate encounters with the little girl and her mother, who complained of a fever (104.9 degrees, according to CBP), flu-like symptoms, and pain. She was given medications, a cold pack and a cold shower, according to the CBP's Office of Professional Responsibility.
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"Despite the girl’s condition, her mother’s concerns, and the series of treatments required to manage her condition, contracted medical personnel did not transfer her to a hospital for higher-level care," the agency wrote.
On May 17, the day Alvarez died, the investigation found she was seen by a nurse practioner on four occasions for a stomachache, nausea and difficulty breathing. The NP recorded normal findings during a check of the girl's heart rate and blood oxygen saturation, and administered Zofran for the nausea at 9:33 a.m.
The nurse practioner also recorded denying three or four ambulance requests from the girl's mother.
Another contracted medical employee reported bringing a pile of documents and a bottle of folic acid tablets from the family's property to the nurse practitioner at approximately 10:30 a.m., the statement read. The NP reportedly did not review the papers, but agreed to administering one folic acid tablet to the child upon the mother's request.
Shortly after the fourth visit with the NP on May 17, the mother returned to the health unit at approximately 1:55 p.m. carrying the little girl who appeared to be having a seizure.
Alvarez then became unresponsive and medical personnel requested emergency medical services while initiating CPR. South Texas Emergency Care arrived at approximately 2:07 p.m. and took over lifesaving efforts.
CBP said the child and her mother were transported separately to the Valley Baptist Medical Center in Harlingen, where Alvarez was pronounced dead about 40 minutes later.
The nurse practioner did document the last two medical encounters after Alvarez was transported to the hospital.
As of Thursday, the review determined that contracted medical personnel and U.S. Border Patrol personnel who interacted with Alvarez or her mother at Harlingen Station were not aware of the child's history with congential heart disease and sickle cell anemia – though Alvarez told The Associated Press she did inform staff of her daughter's conditions.
The review also found that on-call physicians, including a pediatrician, were not contacted by the contracted medical personnel about the child's condition, symptoms or treatment. Numerous medical encounters, emergency antipyretic interventions and administrations of medicine were also not documented.
Troy Miller, CBP's acting commissioner, said the medical contractor who provides care in CBP facilities has been asked to "review their practices and address deficiencies immediately," adding that "several" involved in this incident are no longer allowed to work in the facilities.
"The recent in-custody death of an 8-year-old child in our custody in Harlingen, Texas was a deeply upsetting and unacceptable tragedy. We can – and we will – do better to ensure this never happens again," Miller said in a statement.
It was also discovered that the surveillance video system at Harlingen Station had not been working since April 13, which is a violation of federal law, according to CBP. Since there is no video footage of Alvarez's time at the station, the investigation had to heavily rely on interviews with Border Patrol agents and contracted medical personnel.
"We repaired the closed-circuit television system in the Harlingen Station and have initiated a review of the status of these systems across CBP processing facilities to ensure they are operating properly," Miller said.
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Miller noted that a review was immediately conducted of all medically fragile individuals and family units in custody to "appropriately prioritize processing," and that the average time in custody for those families since Alvarez's death has reduced by more than 50%.
He also said a need has been identified for additional federal clinical resources, guidance and oversight. Lastly, CBP has mandated all U.S. Border Patrol and Office of Field Operations personnel "review the National Standards on Transport, Escort, Detention and Search to ensure comprehension and compliance with this policy."
This incident marked the second migrant minor death in federal custody within a week's time, CBP said.
On May 12, a 17-year-old Honduran boy, who had arrived in the U.S. as an unaccompanied child, died of a seizure while staying at a child-welfare shelter in Florida run by the Department of Health and Human Services.
