Meeting focused on steps taken to improve border facilities to provide medical care as well as medical evaluations given to migrants while they are in customs and custody. [no audio] subcommittee will come to order. The meeting today to receive testimony on the adequacy of dhs efforts to prevent child deaths in custody. The chair is authorized to clear the and recess at any time. Underwood will question. Representative garcia permitted to sit in question witnesses. Without objection, so ordered. Jaclyn was seven years old. Alonso, eight years old. Cordova, 10 years old. An, 16 years old. Carolos, 16 years old. Died in theen custody of the United States government in the past 18 months. They were migrants from Central America who died of preventable conditions that went untreated. Three of them spent the last hours of their lives in detention facilities on the southern border. We must never forget their names, suffering, or the terrible losses their families had to endure. We are here to examine the conditions that led to these avoidable tragedies. We have seen a dramatic increase in the numbers of families and children arriving on the southern border over the past several years. Most families and children arrive from Central America, fleeing cartels, gang violence, and poverty. After surviving dangerous journeys these families should have been met with safe refuge. Instead they encountered the administration inhumane border policies like family celebration, zerotolerance detention, and the mexico policy. These policies by the administration have contributed to mass overcrowding and widespread inhumane conditions across the southern border. Numerous reports by the dhs Inspector General confirm the intolerable conditions. I have seen the problems with my own eyes along with several Congressional Colleagues on this panel on both sides of the aisle. Dhs is consistently failing to maintain transparency by stymieing inquiries. This raises concerns they are hiding serious issues with management in addition to the leadership vacancies at the top of the department. One example is the Department Decision to conceal information on the death of Carlos Hernandez vasquez. He was a teenage boy from guatemala who died in u. S. Custody on the morning of may 20, 2019. They issued a press release later that day calling the death a tragedy and declaring they consider the health, safety, and humane treatment of migrants to be the highest priority. Despite information requested by the committee, it was not until a public report was released seven months later that congress and the public learned more about what happened. His death may have been caused by the failure per divide failure to follow basic for procedures to check on a sick child. While i understand this case is under investigation this lack of transparency by the department is completely unacceptable. The office of the Inspector General must do everything in its power to examine the factors that led to the tragedies. That is why i am externally disappointed the current Inspector General declined our invitation to testify this morning. Especially given the recent news his Office Closed investigations into the first two child deaths in Border Control custody. Summaries of these investigations are extraordinarily narrow. They focus only on whether dhs personnel committed malfeasance and not whether the Department Policies and resources could properly protect children in its care. Even with these two completed reports we still do not know why Felipe Alonso and his father were in custody for six days before philly bay passed away. Felipe passed away. Reporting over the past weekend indicates cbp detains families with Young Children in need of medical attention will be on the 72 hours allowed by the agencies on protocol. This is a disturbing pattern that needs to be remedied immediately or we risk losing more children to preventable deaths in the future. We must act urgently to ensure the policies and decisions that contributed to these tragic deaths are addressed. I hope the witnesses here today are prepared to explain whether the departments current approach incorporate Lessons Learned after these tragedies and how they intend to safeguard children in dhs custody going forward. We may disagree about immigration policy but there should be no disagreement that the federal government must take responsibility for the human beings in its custody. Particularly Young Children. We must never forget jaclyn, darlene,y, darling, wilmer, and carla spared i want to thank the witnesses for joining us and i recognize the Ranking Member for the opening statement. Professionals i thank you for your service at the border. I look forward to hearing in detail about the actions dhs has andn to enhance customs protections to handle migrants arriving at our border in deteriorating health and address preventable deaths. They crisis that unfolded along our border last year was real. It was not the fault of the men and women of customs and Border Protection. It was not the fault of the executive ranch nor the president of the United States. This past year, we saw a Record Number of family units, minors,anied 213 groups arrive at our border during the height of flu season and during extreme heat. Patrol was border referring 50 cases per day to medical professionals. The border crisis was a result of legal loopholes, activist judges, propaganda from cartel, who smuggle in traffic migrants for profit. In 2014 under the Obama Administration the number of unaccompanied minors encountered at the border was viewed as crisis level. Secretary johnson wrote an open letter to Central American parents telling them to not send their children. It is clear that corrective actions were not taken at that time. If that was a crisis, there are no words to describe what we experienced at the border during fiscal year 2019. Not only were more than 321,000 minors encountered by Border Protection family unit apprehensions were more than 590 . Throughout the crisis most cbp facilities were at or overcapacity. Customs and Border Protection personnel were working overtime more than one month without pay to process the large groups. Resources were depleting at record time as personnel at the department were furloughed. You had customs and Border Protection officers still scraping together enough money out of their own pockets to buy toys and bring extra supplies for the migrants in custody. Themselves parents caring to the best of their ability. Began35 day shutdown that in the end of 2018, the federal government reopen january 2019 and the crisis continued. And let the growing issue related to the mass influx of migrants, President Trump made an official request to congress with supplemental funding for the border. Two months went by before we sent money to the field. I colleagues across the aisle blocked the vote on supplemental assistance more than 15 times. While leaders of the Majority Party were repeating a message emergency the chief of Border Patrol was testifying in front of congress that without the funding we could lose the border. The bipartisan Homeland Security Advisory Council released a report on the crisis dating the resultedsupplemental in unaccompanied minors being held and Border Protection for dangerous lengths of time. Voteds on this committee against the emergency supplemental. A no vote meant a vote to keep unaccompanied minors and Border Protection custody instead of at a department of Health Services facility suitable for children. And that releasing thousands of migrants on the streets of border communities. Crisis social Service Resources that should address local issues of hunger and homelessness were completely unable to do so. While the men and women of cbp were struggling to keep the lights on at the border they were subject to partisan attacks. One member even claimed the deaths of children in custody were intentional. Statement, and a certainty and absurdity that was debunked as they found no misconduct or malfeasance by dhs personnel upon completion of the investigations into the heartbreaking deaths of jaclyn and felipe. Every life is precious and one death in custody is too many. That is why i encourage i am encouraged to learn about the immediate steps cbp took to enhance abilities to diagnose the health of migrants in custody and work with the dhs chief medical officer to make long needed, long term improvements. 2018, Kevin Mcallen ordered secondary medical checks on every child and initiated an internal evaluation of cbp care policy. Ance then cbp established approach to conducting Health Interviews in all migrants during initial processing and a subsequent full medical assessment of all unaccompanied minors and atrisk adults. On top of that, customs and Border Protection has over 700 medical personnel and contractors stationed across the southwest border to provide medical support to migrants in custody. Today i look forward to hearing cbpsitnesses about how medical capabilities have improved since the fall of 2018. The collaboration process between cbp to the office of the dhs, chief medical officer and other relevant stakeholders to bolster customs and Border Protection abilities to stop preventable death in their Expert Opinions on how to prevent another crisis in the future. Madam chair, thank you for your indulgence. I yield back. Thank you, mr. Higgins. The chair recognizes the chairman of the homeland committee, the gentleman from mississippi, mr. Thompson. Thank you very much. You whoning to those of are here on the committee. Todays topic is sobering as it centers on the death of innocent children. In our current rapidly changing political environment, it can be easy to move on quickly from past disasters and tragedies. The trumpet assertion the Trump Administration contributes to this by piling scandal on scandal, exhausting the public, the media, and oversight organizations. It is our oversight responsibility as members of congress to refuse to allow the most disturbing and upsetting events played into the past and help ensure they are not repeated. We are here today to examine the treatment of Migrant Children in the custody of the department of Homeland Security in 2018 and 2019 and look at what changes may still be necessary. Detention of migrants did not begin with the Current Administration but an Early Administration of democratic and republican officials took steps to avoid risking the health of the most vulnerable in custody. Under the Trump Administration we now find the elderly, infirm, and children in detention facilities such as Border Patrol stations not designed or equipped to hold people for extended periods of time. Rise inival began to 2018 the decision to detain everyone led to severe overcrowding. The dhs office of Inspector General, attorneys, and members of congress including me observed and reported on the conditions inside these facilities for months. Cbp argued throughout the crisis that they faced severe constraints despite congress providing billions in humanitarian funding in early 2019. Standing room only fails, inadequate hygiene, and family kept outside an extremely unbearable temperatures were commonplace at cbp facilities during the height of migrant arrival last year. Such an environment the spread of illness such as the flu are inevitable. Can be individual deaths directly attributed to specific conditions in a given facility or not we need to understand whether the policies and Resource Management decisions made by the administration put lives in jeopardy. Congress cannot allow dhs and cbp leaders to make poor decisions or ignore existing reasons. And law for this is important for all of us on this panel and has been for decades. Part of our responsibility as members of congress is to check actions by the executive ranch that are misguided. Executive branch that are misguided. I have strong objections to the policies the Trump Administration has put in place along our border that continue to endanger the safety of Migrant Children such as remain in mexico. I hope to hear from our dhs witnesses this morning that the department will take its responsibility toward people in its custody more seriously going forward. One child death was one too many. I am eager to know what the Department Plans to do differently in order to safeguard childrens safety while in dhs custody. I think the chairwoman and Ranking Member for holding todays important hearing and i yield back. Thank you, mr. Chairman. Other members are reminded that Opening Statements may be submitted for the record. I welcome the panel of witnesses. First is Ryan Hastings brian hastings. He is the chief of Law Enforcement Operations Directorate at u. S. Border patrol headquarters washington, d. C. He is responsible for oversight of the day operations at Border Patrol sectors throughout the United States and is a principal advisor to the chief of Border Patrol. Chief hastings began with the Border Patrol in 1995 and has been stationed in various sectors across all u. S. Borders he was promoted to decipher Service Higher service and 2018. Alexander eastman is a senior medical officer for operations within Homeland Security countering weapons of mass destruction. He is responsible for operational medicine across dhs in addition to countering threats to the u. S. Worldwide. He served as a chief of the Trauma Center at parkland Memorial Hospital and is assistant professor trauma surgeon in the division of burns, trauma, and critical care. Dr. Eastman is a decorated Police Officer within the Dallas Police department. He witnesses will be put in the record. I ask that each summarize their statement beginning with mr. Hastings. Good morning. As part of our mission to safeguard americas borders we complete initial processing of addition of individuals before transferring them to our partners. The Holding Facilities were designed for shortterm. We take seriously our responsibility to care for individuals until they can be transferred. 2019 they found it invisible more than 1. 9 million people. We began electing congress, the media, and the public to the unprecedented spike in Central American families that was creating a crisis on the southern border. Our request for emergency funding went unanswered and we began diverting resources from the Border Security mission to address the crisis. As i prepare to testify i reflected on the numerous steps cbp has taken and continues to take in response to the crisis. I cannot be more proud of the extraordinary efforts undertaken by the men and women of cbp. I would like to share you with examples. The apprehension skyrocketed. We had more than we could process. We continue to prioritize processing of uacs first, then families, then adult. 40 to 60 of agents were diverted from securing the border to caring for those in custody. Over 700 personnel provided support at the facilities. We expanded our transportation contract and purchased more than 200 buses and vans to expedite transportation of large groups. We chartered planes and road busloads of whether 43,000 people to facilities with more processing capacity. Prosody processing was complete, we have limited capacity to accept aliens which contributed to further overcrowding. 2019, Border Patrol began releasing noncriminal family units directly into the United States rather than transferring them to ice. Total of 145,000 family members were released. Cbp rapidly constructed six facilities that provided capacity for an additional 6500 families and adults. Stated, secretary azar dhs shelters were full and could not accept uacs from Border Patrol. When they receive supplemental funding a number of uacs quickly dropped from 2700 down to 300. We address the need for amenities in the short term Holding Facilities and were not designed to provide. Facilitiesd the new with portable showers, toilets, sinks, laundry, climate control, and kitchen equipment. We expanded the Food Service Contract to provide millions of meals and stocked countless snacks, water, clothing, hygiene items. We accelerated the expansion of the medical support program. In issued medical directive january 2019 which was superseded by an enhanced medical directive. The directive sets forth foundational levels of medical support for cbp. Utilizes a phase approach through initial observation, medical interviews, and medical assessments to identify potential medical issues. In the last year cbp has dramatically increased the number of medical professionals to more than 700. The u. S. Coast guard and public Health Services personnel were dispatched to many facilities. On any given day approximately 300 Contract Personnel are engaged in more than 40 facilities along the southwest border providing 24 7 onsite medical support. It follows a family practitioner mollo model which was validated by medical experts. It ensures that medical providers are trained, licensed, and credentialed to care for all populations in custody including children and pregnant women. Physicians to include pediatricians provide oversight and training, consultation for medical direction, and medical management. Onset medical personnel may provide care, prescriptions, or recommend advanced care and local health care. Juveniles and 296,000 adults have received medical interviews. Nearly 60,000 juveniles and 95,000 adult have received medical assessments. During 2019, Border Patrol took a total of 26,000 people to a hospital or medical facility on advanced care was needed or requested. Agent spent more than 319,000 hours providing transportation to and from medical facilities. The help of the interagency partners and governmental partners we have eventually ended catch and release. The flow of aliens dropped by 72 . However, these initiatives like the supplemental funding are only temporary fixes. As we have said before Congress Must close the loopholes in the Immigration Services system. Exceeding peak level and overwhelming immigration systems yet again. I look forward to your questions. Thank you for your testimony. I recognize dr. Eastman to summarize his statement for five minutes. Good morning. It is an honor to be here today to discuss the department of Homeland Securitys efforts to prevent child deaths in custody through expansion of medical care. Eastman, senior medical officer at dhs, i have been a practicing physician for nearly 20 years and in addition to my role at dhs continue to be a practicing trauma surgeon. Immediately prior to coming to dhs i was the chief at park moral hospital in dallas, texas. At parkland we care for human beings from all backgrounds and their most desperate times. You care for everyone without regard to race, color, creed, means, religion. It becomes apparent that when life and death are on the line none of these things matter. Providing care for patients no matter the challenges was my goal then and is our goal now. From all of your visits to the border, it is nice to see you, i know you are aware we continue to improve the care for all in our custody especially children. From the medical perspective, the crux of the crisis was a massive increase in the potential demand for care. At times nearly 400 . A number that would gridlock any conventional Health Care System. Additionally, while correctional facilities have embedded Detainee Health care systems, Law Enforcement agencies do not. Cbp is primarily a Law Enforcement organization. Never designed to have a Health Care System within its walls. Doing so would be akin to building a mini clinic in every Police Station in america. Yet our challenge in the midst of this crushing demand was an unconventional problem that required an unconventional solution. To help cbp and other dhs components rise to the task of providing care to an overwhelming number of people including children in our custody. The expansion to where we are today, the system in place, and the direction we are headed represents a herculean effort in response to an unprecedented effort. In december 2018, the dhs secretary directed provision to immediate assistance with the rising humanitarian demand of the crisis. We immediately deployed, for last 13 months, have been working on the border alongside colleagues from cbp, ice, hhs and cdc as well as state and local Public Health, medical experts and professionals to improve the care of migrants. With particular attention to the children and the most vulnerable adults the law directs us to hold. Our First Priority was to urgently expand our medical capabilities along the southwest border particularly at cbp. In support of this missions United States coast guard deployed more than 30 teams to the southwest border providing more than 3450 medical officer 8000 Health Service technician days in the response. The coast guard served as our lifeline. Our Immediate Response force from a medical standpoint. America should be grateful for the truly lifesaving work of the christ coast guard. Also received critical assistance from the United States Public Health service. Our nations assistant secretary for health, himself a pediatrician, with a critical partner as we facilitated the deployment of Public Health Service Officers to critical areas along the southwest border. There are more than 475,000 officers 475 officers deployed totaling 750 days of care provided. No mission was too difficult including loading into helicopters and going to the most remote locations to immediately assess migrants in providing care necessary. Overwhelmed usps in areas without Public Health service or coast guard assistance, we moved them there. These two organizations gave so freely of their time and expertise the officers and physicians and nurses who came down safe less directly and continue to do so with the legacy they have left. As the inner agency was countering the crushing search, cbp was diligently working to build a system that would assume care from the emergency responders. Moresystem now includes than 700 contracted providers, enhanced countermeasures for other diseases, and a medical directive that begins to layout the path forward to continue the process that allowed the system to evolve. Our approach to care and collaborative. That just by coordinating with federal partners but also by building and continuing critical state and local partnerships, collaborative dating with the mexican government. Reviews havematic been undertaken in the last year agreed the approaches sound. Moral, andegal, ethical duty to care for those in custody. The challenge was unprecedented, required an unconventional solution, and we responded. I dhs and across the government we remain committed to ensuring individuals, especially children, receive appropriate medical care. Thank you very much. I look forward to answering your questions. I think the witnesses for testimony. Each member will have five minutes to question the panel. I recognize myself. The publicngs, released video footage of Carlos Hernandez vasquez was being held in Border Patrol custody in may 2019. The video shows in heartbreaking detail the last hours of his life. He was 16 years old. Hoursd in his cell just after a Nurse Practitioner apparently recommended immediate medical care. In fact, his body was discovered by his cellmate who was another child being held in detention. Understanding that the specific cases under investigation, what can you tell us about the learned . Bp has i would start by saying dignity and care are of the utmost importance. I am a father and i have a granddaughter. I watched the video, i saw the same video from the media report and the video itself is troubling. As you know the case is still under oig investigation. I cannot speak to the findings. One thing i can add is that all of the video, all of the items we had has been turned over to oig and they have the video. Not just a piece as i understand that was pulled from the sheriffs department. Are you insinuating there is more i am not sure what you are insinuating. All of the video we had throughout the station that day has been turned over to oig. What did it show . I have not seen it. All i know is that we have turned it over. I was just curious about what you are insinuating by saying we only saw a snippet. I am insinuating we have turned over all evidence. Broadly speaking what do you think could have been done differently, not talking about what was done, your review of the case. What do you think could have been done differently . It is indicated welfare checks were conducted on this young boy , young teen. The video shows an increasingly sick carlos in pain, vomiting up blood, writhing in pain until he falls unconscious to the floor of his cell. This happened over the course of hours. Is there a finding by your internal review that may be it was not understood at the level of medical attention he needed . Again, it is ongoing. Any Lessons Learned from any of the investigations we will look at to make changes. I can tell you we did put out guidance to the field that any of those i believe this was july any subject in our custody receiving welfare checks receiving every 15 minutes and be documented. Mean person, not subject. Yes, maam. That is what they are. People not subjects. Can you tells what policies are in place that recommendations you receive from medical followed are actually and what measures exist to protect health care tofessionals who refuse clear patients for detention . I am assuming cbp officers have to stay with any child or human in detention if they go to a Health Facility is that correct . That is correct. Are you aware of the pressure cbp officers are putting on medical officers so they can get back to their job . No i am not. In reviewing some of the investigation material i saw the contrary where one of our agents asked for additional care and stood up for one of the children that was sick until the fever was down. We see the opposite. That is a good story to hear but there have also been indications that Health Professionals feel intimidated and pressured by personnel to release patients to detention even if it is not medically indicated. To be it seems dr. Should be the ones making these decisions, not cbp officers. What policies are in place to make sure recommendations of medical professionals are followed . Are there policies . We have multiple policies and we work closely with cw md as well as our own office of support. We have medical staff that we have hired to oversee the contract and make sure we are providing the best care we can in the family practitioner model. Eastman, it is good to see you again. When you make recommendations for the medical care of individuals in the cbp custody are they followed . Nice to see you as well. Yes, we were collaboratively with cbp to advise. Place we have employees and this team works collaboratively with the recommendations made with hardy respect to the fact there are considerations as well. If you look at some of the cases involved with children i mentioned, every single one of sick and should have been hospitalized and never released back into cbp custody. There has to be, i would hope, some effort to review where these mistakes were made of these children that were very sick. One of whom had a temperature of 105. 7 when they were initially examined. I dont understand how that could be possible. Our cbp officers trained to i know they are not medical professionals but you dont have to be a doctor to see a child has a 105. 7 temperature. Canaam, we do the best we to provide the best care we can. There is not a mechanism for us at the department of Homeland Security to review the care that is provided outside our system and community hospitals. I was a Nurse Practitioner it was a Nurse Practitioner who gave carlos tamiflu. Have you recommended vaccines . Our approach to the flu vaccine is a comprehensive one that encompasses all the settings along the southwest border. As everyone given given a flu shot . The department of Homeland Securitys vaccination strategy has resulted in more than 60,000 vaccinations being given predominantly in the service corps. We get the right vaccine to the right person at the right time. Have you spoken with the acting secretary about ways to ensure cbp follows recommendations . The direction from leadership, from secretary to the acting secretaries has been the same, to do the right thing for the people in our custody and to Work Together. Youm just asking you, have spoken with the acting secretary about ways to ensure cbp follows your medical recommendations . Yes, prior to his role as acting secretary. Do continue this conversation . Yes. I recognize mr. Higgins. Chief hastings, the president requested emergency supplemental assistance to address the crisis at the border in may 2019. It took two months to get approved by congress and get that money to the field to provide relief. Meanwhile the department of health and Human Services ran out of money. Committeelain to the and americans watching this the Immediate Impact that supplemental funding had on customs and Border Protection operations at the border and cbps ability to move unaccompanied minors out of facilities and into once more suitable for children including professional medical care. Thank you for the question. As everyone is aware, we dealt with 321 total children last fiscal year. These were uacs and in families. We have never seen those numbers before. That quickly overwhelmed the entire system specifically in may and june, 144 apprehensions, inadmissible as well. The system got backed up. 25were processing on average hours for uac. The uac could not move. Hhs was out of funding and telling us they could not move those in our custody. Bylaw there is nothing more we can do with the uac either then turn them over to hhs. Thank you for clarification. In the interest of perspective for the american says distance american citizens and my colleagues and committee, let me just say there has been an undercurrent of insinuation that customs and Border Protection has in some way been neglectful to caring for children. Accept that the medical facilities of the United States of america, the hospitals of america, will provide some of the finest care in the world. Arguably the finest in the world. Death ofnvestigate any any child that is in the custody of customs and Border Protection and those deaths should be investigated. Tragicoss of a child is but we should take a deep breath and look at that. Perspective, of let me say that and to any 17 alone, over2017 3000 juveniles died and professional medical facilities in the United States of america. Many children arrived at the noder very sick, struggling, telling what they have been through. Cbp does their best to take care of them. Includingchildren die 28,308 children in american hospitals in 2017 alone. Those are government numbers from the cdc. Our juvenile detention facilities, it is not uncommon showing an average of about 10 deaths in a sixyear. Period. These are juveniles in juvenile detention facilities in america. Much better designed and equipped to care for the children in their custody. The men and women who wear badges care about the children that come under our care. I lost my firstborn daughter in a hospital. I lost many more on the street. Children in my arms, a young handledden head, and ax over an unpaid drug debt. I held that young mans head whispering prayer into his ear as the life left his eyes. Unresponsive,d, hysterical parents, i did my best to perform infant cpr to resuscitate the child. She did not make it. Eastman, and my remaining 25 seconds, please respond to the spirit with which customs and Border Protection addresses any sick child that comes into our custody. In my experiences cbp officers or patrol agents, Law Enforcement officers, most are parents and they act exactly as you described to do the best they can under the circumstances they are dealt. You, gentlemen. This is the painful and necessary hearing and i think madam chair and the chairman for allowing us to discuss how we can improve the care for our children that come through our border and let us not forget that we must operate based upon a cornerstone that has defined america as we attempt to care for all of our children. I thank you again madame chair for holding this. Apropos of that which you agree that taking 3. 5 billion from a Counter Drug Program would be problematic . There is reporting indicating the president is planning to divert 7. 2 billion to build his wall. Do find that to be problematic in terms of addressing the issues you testified about . Maam, i would add that on the other hand we had a very large influx of families and children. We also had an influx of single adults. 147,000 getaways that we had last year. We had not only asylumseekers but people tried to elude as well. This is a whole government, approached two things we need to protect. To think taking 3. 5 billion does from a military Counter Drug Program would be a problem . Wall. Need a border. I did not ask you that. Can you ask the question again . Do you think it is problemati c that they want to take money from a Counter Drug Program . No, i dont. That is not problematic . For our needs, there are needs on the border as well. While construction is one of those wall. I recognize chairman thompson for one of those. Title of the subCommittee Hearing today is assessing the adequacy of dhsefforts to prevent child deaths in custody. About ones talked death in custody as too much. Since thend that there is a occurred medical director that talks longer do we will no medical assessments for children under 18. Are you familiar with that . Policy that just went into effect is we are doing Health Interviews for all of those less than 18 and we are doing Health Assessments which is basically like a physical for all of those 12 and younger or anyone that says they have a health condition. Dr. Eastman, are you familiar with that . I am. Explain it a little bit for the committee. Approach. S a phased the first to meet medical needs of the population. The first phase involves recognition of illness and the encouragement of migrants to report to us they have an issue. Second, a Health Interview that has been standardized across Border Protection using a questionnaire able to be administered by Law Enforcement officers but developed with experts at the cdc and government with a twofold purpose. To identify him emergent medical conditions and the potential of Infectious Disease that might harm the migrant or United States. Assessmentmedical from a qualified provider. The assessment is given to anyone with a positive finding on the Health Interview or to any child under 12 or anyone who requests it. Last, any true world emergencies someone who has cardiac care are utilizing the local Health Care System. Why would you determine 12 is the cutoff . The way the directive was derived with a collaborative approach from all of us involved from dhs, cbp, and other experts. The way the directive was approached was that a teenager would be able to seek and request medical care when necessary. What outside groups did you talk to when you did this assessment . Adviceave incorporated from the assistant secretary for health, several member of the staff were seasoned pediatricians, we worked with a number of Public Health Service Officers on the border who helped and are pediatricians with vast experience in everything from Disaster Response to responding to ebola. We hired a senior medical advisor from pediatrics, and as a pediatrician with disaster experience to assist us. We continue to listen to the groups that are involved in the care including the american khmer American Committee of pediatrics and other organizations that have given us advice on the topic. We use that advice to form our policies and procedures. I am happy you mentioned the American Academy of pediatrics. Chair, i have a letter from the American Academy of pediatrics that says there is no medical justification to only assess children younger than 12. Consideru to seriously the group you talked about because they are the ones dealing with children. They are saying 12 is not a magic number. Some of us are concerned that between 18 and 12 is a vast shortage of opportunity for us to help children we are talking about today. I just want to put that in the record. So received. Hastings, why did it take diddepartment as long as it to revise this directive . Are you familiar with that . We did put out an interim directive immediately in december and we worked with these various components as mentioned earlier internally and externally to make sure we got this right. The interim policy was in effect since december of 2018. We did not wait to take action. We were taking many other actions including increasing our Contract Personnel even before that. Are you familiar with the clauses subject to availability of resources and Operational Requirements and that directive . Resources and obligations . Resources and Operational Requirements. I am not sure what you are referring to. Same directive you talked about that is been developed . We need funding and it does mention funding to continue our resources. With the assistance with medical fighters. Who makes decisions as to with the resources are available . Based on budgetary need. Who makes that decision . If we continue to receive funding to provide the current services, we will continue to do that. It is based on budgetary needs. Who makes that decision . Toif we receive funding provide the services we are, we will continue to do that. Do you make a decision . Who . We have to be funded. Im not talking about i am saying, who makes the decision, what individual . In the implementation of this directive . As i said, we implemented the directive. When we had difficulty, what you are referring to in staying with the directive would have been difficult when we were backed up. When you say we, is that you . That is Border Patrol. Who at Border Patrol makes that decision . We would make it operationally and provide a heads up to congressional. So there is no individual by name that you can give this committee echo committee . We brief what is going on on the borders in terms of the inverse we are seeing and resources we are using. We can send that we consistently brief but we are seeing in the border and the situation and throughout the crisis, we continue. Im talking about the directive, im not talking about the conditions. , you saiddirective availability of resources and Operational Requirements. Who makes that determination . What individual . We go to the chief or commissioner to stop something as important to this. We would notify other entities if we are forced into a situation, overwhelmed or. Budgeted for this. I am having difficulty you was not giving us a name. It is not a got you question. You have a requirement you pushed out, someone has to be responsible for making decisions on that requirement. , for othersking members of the committee, who that individual is. It would be the chief in consultation with the commissioner. We would advise, like i said is that you . Operations,chief of i oversee operations in the field. So the chief of Border Patrol would interpret the policy we are talking about now in terms of resources and other things . Thehen we did not have resources to fulfill that obligation. Im talking about the new policy that was put in place in response to the death of the children and it said that it is subject to availability of resources and Operational Requirements. I am trying to get a sense of who is in charge of making those determinations. Again, we would have to be properly resourced to carry this out with our contract employees. We have to be properly we have to have the proper funding to do that. Operationally, he would be the chief and commissioner that would pass this down and work with the field commanders and the chiefs in the field. Madam chair, i think my problem is, we had a problem and we have had proposed solutions, but we are not i am not comfortable with who is responsible for carrying it out there point we might end up with another situation because the directive is unclear and subject to anyones interpretation. I am trying to make sure these problems do not happen again. The gentleman yields for 10 seconds. Be happy to. Thank you, mr. Chairman. I believe witnesses attempting to answer the questions to the best of his ability, you are asking for one name and the answer is there are many names. The chain of command is a thattude of men and women make decisions on an operational basis based upon what they are dealing with in the field at that time and they report up chain and down chain. Name, the is not one judgment referred to at the highest level is responsible. But the implementation of a new thecy will be based upon work to be worked on throughout the chain of command. It is many people, it seems to me. You did not help either with the response. Still, for claritys sake, if we come up with a new policy, madam chair, we might have to with a subsequent migrant request, i think it is not unreasonable if policy is put out on an issue this critical, for us not to have those individuals who are tasked with those responsibilities to make sure they are carried out. I yield back. The gentleman from pennsylvania is recognized. You. Ank yearastman, in the fiscal 19, more than 200 large groups of 100 people or more, often of various ages, arrived along our border. Many of these large groups arrived during the height of the months of, and during intense, high heat. Can you give an estimate of how many of these migrants likely arrived at the border with a preexisting illness or Infectious Disease in the fiscal year 2019 . On an individual basis, most of the migrants we saw overwhelmingly where well. There were cases that were not. I will take that back for the record to try to get you a more exact number. Mostly, overwhelmingly, they were well. Your point is exactly accurate. Folks are coming to us after a long journey, many of them with the flu or another disease that need to be addressed. For those traveling hundreds of miles to our border, what was the likelihood they had access to medical treatment along their journey . I am not the expert on the care that occurs prior to them reaching our southern border. We have worked with the government of mexico to try to help them do everything they can to improve conditions on the mexican side of the border, and the department has efforts in central and southern america to facilitate this. I am not an expert on what happens prior to the migrants reaching our border. You mentioned potential diseases have been with these migrants as presented to our border. Can you tell us about that . Predominantly, what we have. Een it seasonal influenza we have also seen sporadic cases ,f tuberculosis, chickenpox some moms some mumps. We have not seen the measles. Those are predominantly the diseases we have seen. In contrast to children with grave illnesses, how many children u. S. Made have been saved by the medical attention how many children have been medical attention given by the custody . From the beginnings of my work, we know about 10 of the migrants that come across will end up going into the medical assessment process. Those are early numbers. How many were saved directly, i cannot pin down. There are certainly lives saved by the response to this crisis. During this crisis, cbp received medical assistance from partners like the United States coast guard medical teams and personnel from the Public Health service. How important is having additional medical staff onsite and cbp facilities . Remember,mportant to cbp is a Law Enforcement organization. We think health care is best provided in debts provided in health care settings. By virtue of the crisis, we had to mount an unprecedented solution. That care that was initially provided by our first responders, because guard, intermediate responders, Public Health service, now that is placed onto the backs of cbps contract and medical providers. That care is vital. We have an unprecedented problem in the system and that is an unconventional solution. I know of no other Law Enforcement agency that i have interacted with or heard of that has such a developed health care infrastructure. In face of this unprecedented crisis, you have been able to provide Vital Health Care . Is that the message . I would not say i, i would say we. This has been a collaborative approach. At the heat of the crisis, i spoke to an admiral and the chief of the coast guard who have changed hats recently, but i spoke to them daily. We, the department, received help from them and other entities to provide what is an unconventional solution to this unprecedented problem. We thank you for doing that. Thank you for testifying in front of us. I healed the remainder of my time. Thank you. The gentlewoman from new mexico is recognized for five minutes. Thank you. Thank you for being here today. 2018, two died after being detained in the district i represent. Anddhs Office Opened investigation into their deaths. Three months later, in this Committee Hearing room, a former secretary testify that she directed the office of professional responsibility and Inspector General to work as quickly as possible to complete these investigations. In may 2019, my colleagues and i urge the department and Inspector General to complete the investigations. Ouroig responded to request, saying it was working to complete the investigations. But it was only last month, nearly a year later, after these deaths, that the investigations were completed and provided to congress. Concerning e the oig limited there was malfeasance by personnel and not policieswhether cbps and procedures are adequate to prevent migrant child deaths. As i have said from the beginning, the reason for these investigations is not to punish people, it is to keep this from happening again. It is to make sure we have the protocols in place in case we are faced with this challenge again. The committees understanding that the investigations did not interview medical professionals outside of the offices of the medical examiner and the department. This is unacceptable, given the significant number of on a Company Children that travel to the southwood test southwest the southwest border. I appreciate the work the men and women a Border Patrol do every day to medicate the situation we saw at the southern border. Thent to find out whether policies and procedures of the agency are setting our agents up for success to keep Migrant Children safe. Received the full reports of these investigations . That is concerned. The committee was told that they had received the committee i have not personally. On the information you received, have you identified specific Lessons Learned that cbp took from the reports and have recommended protocol changes to enforce them . One of the Lessons Learned as we need to standardize a health form across the board for all of cbp. One of the things we saw, there were multiple forms being used throughout this entire year. That is not standardized. You have the updated form . Yes. That is one of the bigger ones. You visited the location where we lost one of them. You are aware of the remoteness and amount of time it would take to get our own agent out of that area. Withnk you are well versed the issues of remoteness and rugged terrain we have out there as well as transportation. We also added a large transportation contract buses and other things to get folks from the border. That is a great Lesson Learned and it is something i saw, so i am pleased Border Patrol is addressing that. Do you have multiple buses under contract . We do. Under contract and our own personal that we purchased, vans and buses. What about pediatric equipment . One of the Lessons Learned is not having the appropriate cuff to take Blood Pressure. Is there pediatric equipment across the board along the border that is available if necessary . We dedicated a large portion of supplemental funding to our emts. Fielde 5000 emts in the and we have updated them with equipment and major they have everything to meet their daily needs. And that is part of protocol, so it is required. If there is a deficiency, and agent has the ability to fill that deficiency . That is correct. Thank you. I want to shift to preventing the spread of diseases in stations. Has are the protocols cbp in place to protect migrants and cbp personnel from the spread of Infectious Diseases such as the flu inside Border Patrol stations and ports of entry . With our Contract Personnel locations,rs, and 40 with the personnel based on the highest flow we are seeing, as well as the least amount of medical assistance in the general area, that is how we decided where to put them. They are fully trained and able to care and provide anytime of antiviral flu and do flu testing. They are able to do that. They are able to do acute care and other things that are not referred to as secondary care. You have protocols that support that need . Yes or no . If you can supply those to supplement the record. We will work to get that to you. My time is expired. Thank you. Recognize the gentleman from mississippi. Thank you. Chief hastings, i want to speak to you on the overall Immigration Crisis that we have and are currently experiencing along our southwest border. On page seven of your written testimony, you refer to fundamental flaws in the immigration system. You go on to say cbp has pleaded with congress to address the players of existing law and judicial systems that impact our ability to effectively manage our immigration system. There are three gaps in our Legal Framework that congress has yet to address. Tv pra, the settlement, and asylum assertion. Theseu expand on each of factors you listed in your yourt and how it impacts departments ability to secure our borders . Ability to be able to hold in a setting provides expeditious Immigration Forces is a major issue for us. And pleading that under the current 20 day process that is required. When we released 149,000 families, when we were interviewing these individuals, they told us we were told, bring a child, and we will be released. That is what is encouraging this large flow that we continue to see. We believe they should be housed together with all the adequate things that have been provided, medical, pharmacy, education, the other things. For uacs standard being able to return a uac to guatemala, honduras, other countries like we are currently with mexico and canada, that would assist with the large number of uacs we are seeing across our borders today. A vulnerable population. To theing the asylum bar low seven bar for credible fears, the backlog of a million cases right now. Would you agree that if congress were to address these issues that you have set forth, it would help stem the flow of illegal immigration we have seen across our border . We believe it absolutely would. You are asked a question earlier about moving or shifting money that was designated from the department of defense to our southwest border for the purpose of wall construction. Do you feel the construction of the border wall has improve your agencys ability to protect our homeland . Absolutely. A border wall system is more than just a wall. Roads,s with technology, gives us situational awareness, and time to respond. I have seen it work personally in many areas i have been in. I have seen what it done for us and i supported. Is there any other recommendations you would make to this committee as to how we can help your department to secure our homeland and those individuals that are within our custody that we can do our best to make sure they are protected and receive the care they need . Notust request, if we are coming to an agreement on the recommendations, we continue to fund hhs, so we can move those uacs through the cycle and get them into the proper environment for care. I would also request assistance with ice funding for single adult bed space. That is another demographic we see backing up in our facilities. Ice needs proper funding for single adult bed space. Thank you for your service to our nation. I yield back. I recognize the gentleman from new york. Thank you. I think our witnesses for testifying before us today. You testified before the Judiciary Committee and my college asked whether a threeyearold girl could oppose a criminal or National Security threat and he responded, i do not know. Attitude goes a long way in addressing the multitude of issues that you have before you, but specifically preventing child deaths in attitude goes ay in custody. We should not be surprised when children do not receive medical attention they need, particularly when we do not know whether a threeyearold can pose a criminal or National Security threat. That, last fall, i nationald hr 3777, the to investigate the Migrant Children act, which would create an independent commission to study family separation and the debt of children in cbp custody. Legislation,ing my we have to rely on the Inspector General to get to the bottom of these matters. In a report released by hhs, it states that a Border Patrol supervisor had to pay out of their own pocket for an overthecounter medical care for an eightyearold because Border Patrols assurance did not cover it. In addition, the cbp emt was i able to take a Blood Pressure of a seven role because they lacked a pediatric cough. What steps has cbp taken to ensure access to basic medical necessities and equipment across the southern border . Thank you for the question. We did see an issue or a problem cbp, being able to fund nonprescriptions overthecounter. We have since fixed that. We have a contract through ice to be able to purchase any remedy that is prescribed. We have that. Additionally, thank you for the supplemental funding, we were able to provide muchneeded agreement for our emts in the field. Those have been fixed. Wonderful. I appreciate that. 2018, decade prior to there was not one single child death in custody. Theret concerned seems to be a callousness taking place. I invite we are focused on this. However, if we are able to shift funding for a border wall, we should be able to shift funding to save human lives, particularly the lives of children. We need to understand what went wrong in 2018 and 2019. If a cbp official failed to take steps to prevent the death of a child, what kind of disciplinary measures do you think would be appropriate . I have not seen hypothetically. To they thing that went report, i would have to see the specifics. If it was negligible, we would take immediate action. Has any official faced accountability for the debt of children in custody . No. There has been no negative findings. No problem. How does cbp determine what expense qualifies as medical care . How do we determine i did not hear. How does cbp determine what expenses qualify as consumables or medical care . Metal part system, which is administered through ice, the dhs system that pays for care of migrants and our customer. Our custody. Can you provide examples of products or activities for which consumables and medicare funds have been expended since . D think thank you for this elemental funding. They have a standardized formula of medications and equipment that is used to carefully migrants in custody. That is an example of how money has been appropriated to further the care of children in our custody. How is that replenished . How do the subcontractors are they im not an expert in their supply chain management. They have a system that replenishes those. Very well. I yield back. I recognize the gentleman from california. Thank you. Thank you for being here today. I am a member of this committee as well as the house Judiciary Committee, where we had numerous oversight hearings concerning the the tension facilities and adequate standards of care for migrants, including children. I am troubled by the multiple reports of overcrowded facilities. I have toured some of those facilities. There is an agreement that cbp cannot your facilities are not meant to handle the influx of children and families that we have seen over the last two years. My question is, what contingency plans does the department have in place to ensure the safety of those within your custody . There are a couple things i would add. Facilities with wraparound, medical, food services, shower, pretty much all amenities. Additionally, we have planned longterm to put Central Processing Centers in our busiest areas, the rio grande valley, el paso sector, and you must sector. Those are being completed now or will be completed and started in the spring. Being completed now for el paso. Facilities and those Wraparound Services is something we are planning for and we have a longterm solution. I know you are chief of operations, but if we can pull back a little bit, when general calley was secretary of Homeland Security, he testified i will paraphrase Border Security goes beyond our border. Myself, you doo not wake up one morning and think, look at all those folks at our doorstep. I have to imagine you coordinate with other agencies and federal governments with other governments and begin to see moving. W of migrants my thought is, how do you prepare or are you preparing for those ensuing waves of refugees that are coming, not only from south of the border, not only from Central America, but other parts of the world . I do not see this as a one incident phenomenon, but as a world areas of conflict continue to escalate, you have folks in harms way, this is going to continue to be a challenge, migration, refugees from around the world. Are you doing anything to anticipate these kinds of situations . We are embedded with multiple governments, we work with the northern triangle and have agents working with them now. Also work strongly with our mexican bar enforcement partners on a daytoday basis. May i add something . Bordertion to what the patrol does, the National Surveillance information center, entity, works continuously with our partners, not just mexico, but its out of the border at worldwide, to andy and recognize it recognize healthbased threats. My calix talked about the flu vaccinations my colleagues talked about the flu vaccinations and your response, i believe, operational challenges have prevented you from vaccinating a lot of those individuals that need it. That is not my response. What is your response . Our approach is comprehensive. There are migrants who have come into custody who have gotten vaccinations, including these catch a particle at hhs. We administered more than 60,000 independent vaccines, are you moving in that direction . Of independent doctors volunteering to get you up to speed to get there, that is not a factor . Youre doing fine on your own . Medical volunteerism is a challenge to organizations. Difficulties in utilizing volunteers and the difficulties with licensing and administration, we encourage them to volunteer in the book of hasrnment shelters and cbp done work to vector those volunteers into places that can utilize them. I am running out of time but i would like to follow up on the issue of the challenges of having licensed doctors integrated into your system of being able to vaccinate some of these children and deliver medical services that may be cbp is not able to deliver because of limited capacity, and if i can get 30 seconds, you made a statement that mexico is trying to improve on their side of the border, some health care are we coordinating with the mexican authorities in terms of making sure health care does the stud disease does not respect the border. Are we addressing both sides . The chief medical officer made a visit to mexico city last year, we continue the dialogue and to Work Together to make the situation i would like to have written testimony on that later for review. Thank you very much. And thank you for being here. I recognize the gentleman from texas. Thank you. I appreciated the opportunity and i think the witnesses for appearing. To both of you, did you take the president seriously when he makes comments . What comment are you referring to . He is our president. You hear his comments. I do not know what you are referring to. About the wall. I think the wall works from my experience. You take them seriously then . On the wall . The wall works. You think mexico should pay for the wall . All i can tell you you take the president seriously, dont you . I know the president said mexico should pay for the wall. I am not involved in funding the wall. I am just telling you you to be president seriously. Lets go on. Woodley be will have saved . Would the wall have saved . I do not know the answer. I see. Let me ask you this. Sorry . Seeke the people who asylum criminals . People who cross the border illegally is . You know what and asylee are asylees,s, people seeking asylum, are they criminals . We are asking them to go to a port of entry that has little to do with my question. My question is, are they criminals . Why are you aerating . Why will you not state what you know to be the truth . Why are you doing this . Are asylees criminals . If they cross the border illegally, it is a crime. Where do you find this in the law to support your position that people who are seeking asylum are criminals . Are the babies criminals . This is why you treated them the way you treated them . You perceive them as criminals . Babies are not criminals. They have no malice. What would you recommend we do to prevent future deaths . As i have discussed, we are taking a lot of those actions and have been taking those actions were some time. We are taking the right steps now to prevent further deaths. It will be difficult to say we will prevent every death. The people we encounter on the border, many of whom have traveled 2000 miles, some have never seen health care, some never had treatments. Them, ine running into many times, in their worst case scenario, we are doing everything we can to get them treatment. Again, what can we do, meaning congress . Actionsg some of the for noncontiguous uacs, that is one. Quit drawing uacs up to our border because we are unable to return them unless it is mexico or canada. As i mentioned, the floor is fixed. Everyonee to hold together, the family and the proper setting while they go through their expeditious hearing. Purposes, uaction i find it to be a pejorative. Is in the law. I understand. I still find it to be a pejorative. These are children. Uacs. Yieldchair, i am going to back the balance of my time. I recognize the gentleman from illinois. Gentlewoman from illinois. My oversight of trips to the border last year, i heard firsthand about the need for resources to improve medical Record Keeping. As a nurse, i know how important clear Record Keeping is when it comes to Patient Outcomes and ensuring Health Care Providers can effectively do their jobs. In response to what i saw at the border, i am proud that we passed Bipartisan Legislation last year to provide cbp with an Electronic Health record. If you days ago, President Trump signed a package that included 30 million in dedicated funding for that Electronic Health record. As a physician, can you tell us more about why ahrs are important to your work at the border . Thank you very much. And thank you for passing the funding we need. Ea charge survey specific function. They are not fully document the care provided, but they allow us easy access to the data to do things like quality assurance. It assures we are able to measure the care we are providing, it ensures we are able to assess the quality of that care, and ensures we are able to learn lessons from that. That we intend to develop will improve our ability to conduct disease and Health Disease surveillance using Artificial Intelligence techniques that will trigger the presence of an at that just disease before a human being can pick it up. As your perspective, how do ehrs better communicate patient care . They are a complicated topic. They allow us to describe the care we provided from the point of apprehension to the point of release. Not only internally, communicate internally across settings, but they allow us to communicate to external partners. When other the things that is important in this hearing to mention, the system not only protects migrants, it also protects the integrity of the Health Care Systems in local communities. Where are we not absorbing some of the blow, these local systems would be overrun. I sent or are happy Electronic Health records and we know dhs has begun the process of building one. Along with a dedicated funding, congress directed dhs to come up with one in 90 days. Can you give us an update on where dhs is on this process and what specific actions have been taken . Right now, we are in the first phase of this, which is to identify Immediate Solutions that can integrate the existing technology. That work is ongoing. We are working to plan for the longterm. We hired a chief medical officer who we think has the talent and expertise to help us build a system that will not only create an effective customized solution for us, but will harness our ability to help our operators do their job effectively. Everything we do has to take into account the affects it has on the operator doing the job at the border, at processing centers, and ports of entry. What are the next phases in the implementation . , we work ourhase fingers to the bone to get this plan together, to preview you in 90 days. You mentioned you hired this officer. What date were they hired . I will have to take that he has been around five or six months. Why is it important to enter cbps hr is that ehr is operable by other dhs components . We want to make sure we are able to provide a seamless picture of all the care provided from the point of apprehension to discharge. It is important for a provider to know what happened upstream of that when the person for the care provided. That being said, we are working with the Border Patrol to make sure the solutions we craft together. Ob accomplish the goals of the ehr, but are userfriendly and do not add to the processing load that the operators have to put forth to take care of the migrants. I appreciate those operational benefits. The other benefit is saving lives. Youre not missing information, not losing patience, not missing opportunities to identify diseases or changes in current status. We are heading into another flu season that is projected to be savvier. You noted in your testimony you are working with cdc and other Health Agencies to improve cbps response. At dhs taken to respond to throughout breaks during this current flu season, which has been particularly harmful and deadly for children . Season, it appears it may be rough. We have worked with cbp to help that flu control measures were crafted with input from experts from the cdc when they performed an assessment along the border early on in the crisis. We have helped provide cbp with the ability to diagnose and treat the flu in our facilities. That capability is present in over 40 facilities and i would challenge folks to find another lawenforcement agency that diagnoses and treats the flu on the lawenforcement side, not a custodial side. One last followup. What date wasnt new for this flu season that capability has been deployed . That has been developing all along through the course of 2019. As contract support has developed, that flu capability has been put into place over the years. Thank you so much for appearing today. Thatask unanimous consent representative jackson lee be able to question the witnesses. Without objection. I recognize the gentlelady from texas for five minutes. Thank you very much for this hearing and let me thank the witnesses for being present today. It is important. Let me be clear that you handle Law Enforcement operations covering u. S. Border patrol and customs and Border Protection . No, just Border Patrol. Alright, this is a typo. It has you in both positions. And you are not. Just wanted to clarify that. Just Border Patrol. All right. Let me, for the record, take note of the fact that a number 2018,ldren that died in in fact, no child had died in cbp custody for the entire loste before 2018, and we jake flynn, philippe a, a number of children that proceeded to get medical care and who were detained and placed in cbp and ultimately, four migrant orldren passed away while in shortly after being released from federal custody. Whether you you, have children or not, or are around children or relatives, acknowledge that the debt of any child the death of any is a crisis and tragic . I am a father and a grandfather. It is a tragedy. Dr. Eastman . I am a parent and the debt of any child is devastating. It is important to not and they know not only know it is utterly devastating to the parents, but i was in our facility and i sought our personnel who tried to save jacelyn, and they were not successful. If that is brutal on the caregivers as well. You go to my point. Dying in the custody of individuals who are basically lawenforcement, but seeing when they are committed to defend and protect alongside of the immigration responsibilities, their cheap responsibilities, that that is tragic for them to have died. Is that your opinion . Any person inf lawenforcement enforcement custody is tragic. Lawenforcement officers take seriously their responsibility that when we place our handcuffs on someone, we have a moral duty to care for them. A child is particularly vulnerable. I assume you agree . Any death in federal custody of a child is tragic . It is tragic. Of those officers the averageseeing they made during difficult times , buying diapers, getting formula, that should be put on the record. Point i key appreciate the steps congresswoman underwood has made, we traveled to the border several times. My question would be, is it time reports, you present to stand up a parallel medical system based on the present policies of this administration, meaning that i saw being denied, they are not being able to access asylum in the way it should . Whereare migrant camps disease is rampant or to be rampant. When they come over, they may be sick. We have an effective medical system that is parallel to your Law Enforcement system that can do additional things besides the records being done and other aspects of reporting, a semiquasihealth center for these individuals come again . I think we have to be cautious that we can fab late a Health Care Facility with a Law Enforcement facility. We believe that dhs and it is my personal belief that health care is best provided in a health care setting. What we are to continue to do is facilitate the movement of people through our system to the best place to care for them. For children, hhs, for adults, in ice custody. We have to harden the system for the times we face Unprecedented Demand for care. I believe that is what we are doing right now. Can i have a quick followup . Hastings, your point on this parallel Health System . I would agree. To see uacs come up vulnerable populations out of our custody as quickly as possible. That is what we want to see. To the proper places where they can receive care. It might have been misinterpreted, i want to establish that is not the case. Of children were not out your custody as soon as possible. We have challenges with a system that i help set up, we will put that aside. My point is, there be some process that is more substantial than the Law Enforcement that can do Immediate Care besides putting someone in a police car and trying to rush them to the nearest hospital. The question is, do we have an effective Emergency Response on site that can deal with some of these crises, such as one of the young man was found nonresponsive, there was not much to deal with his nonresponsiveness. Question, weyour are going in the right direction. We have went from three sectors covered by medical personnel, tune out nine. They are in our busiest locations where we need them. We are monitoring to make sure we have them where we need them and we will continue to do so. We have 1500 emts that can provide support. We are taking all the right steps we need to. Dr. Eastman . Our strategy is to provide the right care to the right person at the right time. I believe we are taking the right steps currently to do that. The right to reassess the system continuously. It is our belief that dhs at my believe personally that we are moving in the right direction. I look forward to that report so i can understand the system. I think the chair and i yield back. The chair recognizes the gentlelady from texas. Thank you. Thank you for your vote waving me in to sit on this committee. Thank you to the witnesses. I have been following this issue for a number of years, beginning with the first influx when i was senate coxes in texas. I visited 10 facilities under the jurisdiction of cbp. I have seen the differences in a lot of the medical protocols, a lot of the medical care that is provided and of different facilities. I must say, i have never found them to be adequate. I have never found them to be a clinic or hospital. To borrow the words of my no one is asking for a hospital. Reference you cannot put a clinic in every substation or police department, facility. I do not think we are asking for that either. Is what many of us have been talking about, the right protocols, the bite screening, to make sure we get on it as quickly as possible. I was completely stunned at the lack of any kind of screening that was done in the new mexico facility. About theue talked jacelyher district, when n died. They took a microwave off a table to let her lay there because there was nowhere else to put her. This was when they were waiting to get the transportation to go to the facility where perhaps she could get more treatment. Of course, she ended up going to the hospital. Are you telling me, under todays protocols, that has changed . You visited lovebird also. We do the absolute best we can under the circumstances we are provided. Committee, when we were faced with Unprecedented Demand for care for large groups has that changed in that facility now . They will not have to remove the microwave to put her on the table . They will have a screening method so they can detect it sooner to get her somewhere . A lot of our areas have changed. Including el paso. Topaso has a soft side, soon have a modular facility as well. That will give some increased capability and some increased space that we need. Still, many of our stations and many locations have not changed. They were built for a different demographic. They have not changed. We have added as much as we can in those locations in the way of food health care products. They were not built to house for long periods of time. I would still like dr. Eastman just to be clear, the system that is in place today, by virtue of the growth and hard work of a lot of people across the government bears little recep lens to what it looked e at christmas time 20 2018. A lot of ports of entries that we are used to using, they are not allowed to get close enough to make entry. That oneion is, has now been improved . If someone presented themselves with high fever, chills, typical flu symptoms, would that person be put on the same table . I will give two answers. At first, the expansion of contracted health care allows the Border Patrol to use their emts in the role they were designed, not to be screening personnel inside facilities, but be outside in the field caring for our personnel and anyone else. That is a no . There iscond thing is, contracted support in multiple locations, and we will take for the record to get you the details of where that support exists today. Texas,g the border of there is some screening protocols to ensure this would never happen again . Yes. The approach that i described earlier in this hearing is in place all along the southwest border. All right. What about the medical assessment or screenings, are there any in place for the post in the migration protection protocols . Are they screened at all . I am hearing there is a lot of people on the other site of the border that had been turned away under this new program that are very sick. The care that occurs south of the United States border is outside of my scope. Im not sure what is being done on the mexican side. They will go through medical clearance prior to us, putting them and returning them. They will go through this same process prior to being returned. There is a map up there that aslines where we are today far as those 40 locations that we have contract medical service. I realize, we are looking at a bunch of dots on a map. Over 300 individuals on duty at any given time providing that medical support to our agents in the field. Telling me, although they are being turned away, you do screen them . Can i take that one . Theroach to medical medical assessment applies to everyone. These folks were not in custody, you are turning them away. If they are in our custody, they get the care described. It is outside of my scope to know what happens to them south of the border. Madam chair, partly the witness is not understanding the question. Im talking about the folks being turned away. You will have an opportunity to ask that again. Do you have additional questions . Yes. Before i asked my second round of questions, i at unanimous consent to submit the file report by the cdp, families and Children Care panel, which was established in november of 2019. I asked unanimous consent to submit it for the record. Received. Would you like to clarify the that all humanng beings that cross the border and come to into and come into our custody, they are subject to . Would you clarify for my colleague and for the rest of the committee . That is correct. Anyone that comes into our facility, regardless of what program or initiative they are doing and to will go through all of that medical assessment, medical screening at interview. Are you clarifying, that includes children, all individuals returning to mexico under the program, prior to being returned, receive medical screening . We still have to process them. What if they are sick . We will take them today what if they are sick . They will go to the hospital or appropriate medical care. If he screening determines they are sick, to the extent they need professional medical attention, we are getting them that medical attention before we send them back to mexico . Yes, as evident that is the policy across the board or one location . That is acrosstheboard. Thank you for clarifying. You mentioned the working relationship between cbp and the office of dhs chief medical officer. Can you go into more detail about the specialized nature of your teams assistance to customs and Border Patrol and based upon your observation, how our office on Border Patrol and cbp communicate constantly. The cbp senior medical advisors is employed from our office embedded into cbp to help facilitate these issues. The relationship is handinhand and we communicate literally at multiple levels daily. With regards to your second question, my direction has been clear. Our direction has been clear from every leader in the department whether that is at dhs or cbp. The director direction i was given rep. Higgins what about the direction you have received . Dr. Eastman yes, there direction i have received has been clear and unanimous. Rep. Higgins at the executive branch and our president is their leadership to expeditiously address in custody medical capabilities. Dr. Eastman i have not spoken to him directly but my directions come from the secretarys and commissioner. It has been clear, loud and unanimous, do the right thing, break down barriers and take good care of the people in our custody. Rep. Higgins that message has been pushed throughout the chain of command . Dr. Eastman yes, it has been you and emmett been unanimous and loud and clear. Rep. Higgins thank you for your clarification. Thank you for the second round of questioning and i yield. I now recognize a gentlewoman from illinois, ms. Underwood. Rep. Underwood i have a couple of followup questions based on what was said today and the written testimony. In the written testimony, im going to read a couple statements. The enhanced medical directive ensures cbp well and will sustain medical support capabilities with an emphasis on children less than 18 years old. This includes a Health Interview upon arrival. Delineategs, can you whether those facilities include all Border Patrol stations . Mr. Hastings it does include all Border Patrol stations, yes, maam. Rep. Underwood then, to circle back on what was recently discussed by mr. Higgins, that if it includes the Border Patrol stations for individuals brought into apprehension with the idea that they will be put into this thennt the mbp policy, you consider that under u. S. Custody, correct . Because ok. Those individuals all get a Health Interview. Mr. Hastings thats correct. Rep. Underwood and if those individuals are seen as having some kind of medical flag, to use a casual term, then they will get a magical assessment . Mr. Hastings thats correct. Rep. Underwood dr. Eastman, can you confirm that is happening . Dr. Eastman absolutely, maam. And in the locations where we do not have contract and medical support, we utilize local resources to get that assessment. If the interview occurs and if folks need health care and we dont have it there, they will get it in the local system. Rep. Underwood ok. Just to reiterate, the individuals coming to the United States that under current policy under dhs, you all want to send them back to remain in mexico or go through the mbp and they present with a health care issue, you are saying they are getting both an interview and a screening and it is at that local facility, they dont have the medical staff on to do the screening . You are sending them externally to get that completed . Dr. Eastman if they have a medical need, we will utilize the local Health Care System. Rep. Underwood ok. Pagellowup question is on testimony, hastings he says currently each day, there are approximately 300 contract and medical professionals engaged at more and thefacilities, support is available at all nine southwest border u. S. Bp sectors, and all fourth southwest border offices. Based on that, would you consider there to be 100 coverage . Mr. Hastings no, maam. I would not. As i mentioned earlier, we believe we have about 10 more locations we need to cover that we are working rapidly to get coverage now. How we determine where this went was where the highest vulnerable population was, where we had the lease medical support in our nearest areas, and the highest flow rate we are seeing. We have 10 more locations that we are looking to expand to now. Rep. Underwood do you have the current funding to support that expansion . Mr. Hastings we do have the current funding. Rep. Underwood ok. The numbers submitted in your testimony are current as of what date . These individuals and locations were staffed as of what date . Mr. Hastings into december 2019. Rep. Underwood ok. Thank you, madam chair. I yield back. We where are the 10 additional locations . Rep. Underwood i would have to look at mr. Hastings i would have to look at the chart. I now recognize a gentlewoman from texas, miss curcio. Rep. Garcia thank you. Just a quick followup. This are hastings, what is the average stay of these for a child in custody . Mr. Hastings that varies from day today, our to our. On average, the hour the average time is approximately 39 hours, the last time i looked. Rep. Garcia 39 hours. Mr. Hastings the last time i looked, yes. Leaving our custody quickly. Rep. Garcia ok. Do you remember what month that was . That is all beasley not the numbers im seeing. Mr. Hastings it has been a while since i have looked. It is the time, one of the many variables we look at. The point being rep. Garcia shy of two days. Mr. Hastings we are doing very well of individuals mailing rep. Garcia let me ask you this. I dont know the age of your grandchildren, but would you be comfortable with having your grandchild in custody in one of your own facilities for 39 hours . Mr. Hastings i dont want any child in my facilities for that long. Rep. Garcia would you be comfortable . Mr. Hastings im sorry, in the crisis. For 39 hours, i trust our employees are taking good care of the detainees that they are charged with oversight. Rep. Garcia so you would be comfortable with if your grandchild was there . Mr. Hastings i think we are doing very well providing Proper Services for all of those in our custody right now. During the crisis, no. I would not. Notnt want them i would my granddaughter in custody anywhere, but i think we are doing the best we can with everything we have out there on the border now, with all the improvements we have made and how quickly we are getting these unaccompanied alien children out of our cup our custody. Rep. Garcia what about you, dr. Eastman . Little would you feel comfortable with a member of your family being in custody . Dr. Eastman with no offense to chief hastings, im a little young for grandchildren. Rep. Garcia i never make assumptions, ive learned in this business. Dr. Eastman i understand. I went to be clear that it would be my preference that we do not ever hold children in our custody. Rep. Garcia that certainly is my preference if the child has not committed any crimes as my colleague from texas has said. Dr. Eastman let me be clear from my perspective as a physician, that we provide our care irrespective of circumstances. It does not matter what they have or have not done. Our care is provided to every human being in our custody. The same no matter what the circumstances are. To answer your question, i would be comfortable with my children receiving care in this system if it were necessary, and i know we will continue to do everything we can to improve it every day. Rep. Garcia let me follow up on my colleagues questions. Like him, i serve on the subcommittee as the Judiciary Committee on immigration. He was asking about volunteer doctors. I know im from houston. We have a Large Medical Center of which we have a lot of doctors around. Many of them do a lot of good volunteer work in a number of areas and many of them do missions abroad. Me thate mentioned to they have tried to help and tried to volunteer, tried to even bring, especially the flu vaccine, to some facilities. What is the rule be whether it is texas doctors and they are willing to help, why wouldnt we allow them to help . Dr. Eastman just to be clear, i a texas doctor as well. Rep. Garcia i know that. I saw your resume. Dr. Eastman but the provision of voluntary medical support presents challenges, not just to the department of Homeland Security, but to medical organizations in this country in every state. While we sometimes have difficulty with the licensor and administrative requirements, and we have done this, we have tried to vector volunteers who want to provide that help to some of the other locations that are not as fortunate to have medical support like we are, like the ngos shelters along the southwest border. When we have had texas volunteers, we have tried to vector them into the texas ngos that need help. Oftentimes, while that is not my role as a dhs senior medical officer, we have been thrust into that because in many ways, we are the intermediary between those medical volunteers. You are from houston, i talked to dr. Medic almost daily. We talk routinely about things like this. One of the things i think that is important is that during the course of this crisis, we have worked with state and local Health Departments and doctors all across the southwest border. And it has been a hand to hand direct facetoface meetings and working together to fall solve problems. We have tried to be the best partner possible to the state on local Health Departments along the southwest border. I think some of you saw evidence of thought when you came and visited the border and saw those interactions. We will continue to do that, you have my word. Rep. Garcia what impediments or challenges are there and would it be anything that we can do in terms of legislation to be able to provide, you know, better access to volunteer doctors . Dr. Eastman my suggestion is we take this offline and Work Together. The provision of volunteer services and disasters and volunteer medical services in this country is something we are interested in. It is a tiny bit outside the scope of this hearing that i would love to Work Together with you to help solve this problem. Rep. Garcia i think it is in the scope not only for this hearing that is focused on cpb, but we have the same challenge and even volunteers who want to help children that are in our facilities even something as simple as taking them to the movies. Some of these facilities wont allow people to come visit the children in any way to assist in terms of particularly their Mental Health wellbeing. We will take it offline and dr. Maddox is a good friend so we will make it a three way call. Dr. Eastman cupid love that, maam. Rep. Garcia thank you. I yield back. Let me say that i think i can speak for my good friend, mr. Higgins Ranking Member, but i want to thank mr. Hastings and dr. Eastman for coming today. There are people in positions above you who dont show up. Who dont answer the call. Which is their duty. The fact that you two showed up ,nd took difficult questions you know, im grateful. Im very grateful. You could have done what they did. We are well within our constitutional obligation of having a role in oversight, i want to thank the Ranking Member on this subcommittee because we have been trying to address this issue. Before anyone is a republican, democrat, black, white, male, woman, we are all human beings and we are all americans. I can say for everyone in this room and on this committee that even one death in custody is a tragedy. Dr. Eastman, i remember meeting you before you even got the position because it was one of the issues we tried to address, how quickly we can bring qualified people like you in to help solve this problem. I want to thank you. I know you had contact with my colleague, ms. Underwood, who has a medical background. It is relationships like this that will help us all address these tragedies and ensure that they dont happen again. These are children who are being brought here for a better life which is all any of us want for our children. I thank the witnesses for their valuable testimony and the members of the subcommittee. We ask of what we have spoken about during the questioning, we ask you respond as expeditiously as possible in writing to those questions. Without objection, the record shall be kept open for 10 days. Hearing no further business, the subcommittee stands adjourned. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] announcer 20 president ial candidate senator elizabeth hornng elizabeth continues to caucus in iowa. We will have coverage as she speaks with potential caucusgoers. Leave monday at 4 30 p. M. Eastern on cspan. Senators, i attend the senate in conformity with your notice for the purpose of joining with you for the trial of the president of the United States. I am now prepared to take the oath. Will you place your left hand on the bible and raise your right hand . Do you solemnly swear that in all things appertaining to the trial of the impeachment of donald john trump, president of the United States, now pending, you will do an impartial justice according to the constitution and the laws so help you god . I do. God bless you. Thank you very much. Time, i will administer the oath to all senators in the chamber in conformance with article one, section three, clause six of the constitution, and the senates impeachment rules. The law senators now stand or remain standing and raise their right hand. Swear that iny all things appertaining to the trial of the impeachment of donald john trump, president of the United States, now pending, you will do impartial justice according to the constitution and laws so help you god . I do. Announcer for the third time in history, a president is on trial in the u. S. Senate. Watch live tuesday when the trial resumes at 1 00 eastern on cspan two. Next, we hear from 2020 republican president ial candidate and former illinois congressman joe walsh. At a conference on politics and marketing, hdiscussed his Campaign Strategy and President Trumps impeachment. Afterwards, he took questions from the audience, at these event hosted by media post in washington, d. C. It is an honor to have you here. Mr. Walsh it is an honor to be here. Thanks, everybody. Host full disclosure, i have been a lifelong democrat, but i dont think there is a republican candidate i have rooted for more than maybe abraham lincoln. Mr. Walsh
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