Implement the revised medical screening proceediers, and the improper expenditure of emergency funds appropriated by congress for the care of migrants. In december, two children died in custody. A sevenyearold girl named jacqueline and an 8yearold boy named felipe. Last year another three children died in custody or shortly after being released. On january 4th, 2019, i sent a letter to the department of Homeland Security requesting documents relating to the deaths in 2018. After they failed to produce all documents responsive and in november and they keep my of the communicating requested in my letter ten months prior. The expecter Generals Office issued two one page sum mum rars. But the questions were left with more questions than answers. Earlier this year i sent a l letter to the expecter general. My entire letter is available on the committees wps. Among the concerns i raised were the following. They say there was no malfeasance or misconduct by dhs personnel. It was unclear why that was used because there did not appear to have been any mal fee sals. Border control agents showed great passion for children. However it appeared to people that because they found no malfeasance that was the end of the story. The report fails to examine the many troubling questions that these deaths raised regarding the ability to care for children in custody including questions about the adequacy of the policies, procedures, and training. Further, while the expecter Generals Office conducted many interviews, it appears that key documents and evidence were not collected and reviewed. My letter also vooifed omissions in the public summary of one of the expecter generals report that was so severe it rendered it inadequate and possibly misleading. They refiezed a public summary. In the past six months they produced some documents in response to the committees subpoena, but these are clearly incomplete. For example, they referred documents that had never been provided to the committee. Dhs also made extensive redakotass in the documents it produced. Though its refusal to comply fully with the committees subpoena and through its many redakotass the department is intentionally impeding the committees investigation. Despite these hurdles, the committee has worked to advance the investigation. We asked a people transcription and a medical examiner to conduct independent examinations of the two kets thdeaths that o. Today the Government Accountability also is also releasing a report that we requested. It includes use of emergency funding appropriated and t agencies implications. They claimed they urgently needed emergency funding to provide care for migrants take into custody, the Border Patrol agents that cared for phillippe had to pay for medicine out of their own pockets, but they appropriated funding to pay for medical care to buy jet skis, dirt bikes, and dog food. There is something seriously wrong with this picture. Just as there is seriously wrong with the administrations approach to caring for migrants, including children. A note that the gao report found that all of the cdp adopted policies governing medical assessmen assessments, they did not consistently implement these policies. We welcome dr. Anna anher and dr. Mitchell before the committee and im glad that after initially refusing to do so, the Inspector General has agreed to testify before the whee so that we can exemployee the questions and we also invited mark morgan to testify. In a letter to the committee he stated that because of the white house baseless rules, prohibiting witnesses from attending virtual hearings that he could not appear. I fully recognize the sensitivities of the issues that we are adiscussioning. I ask all of the members to be thoughtful in how we approach the subject. It is clear this administration will do everything it can to avoid oversight. We need to do everything we can to hold this administration accountable. 18 months of obstruction we have endured and have sought documents and information about the death of children in custody and issues like the administrations child separation policy. And to be able to identify changes needed and the immediatiers needed than to continue on todays hearing. Im going to read daytimes from the fathers of the two children that died in custody in 2018. Mr. Cal cruise said i would like to say what i have always believed. It is better to check on all children when they are sick, and even when they are not sick. To speak up and Say Something even if youre afraid. The most important thing is to check on the children so the thing that happened to my daurn will not happen to anyone ever again. I offer my thanks to the committee for taking the time to check into my daughters case. The father of felipe says i want justice, i want to know why my child did not get care in time. This is painful for me me today and painful for the rest of my life. Ski myself why my son did not get medical attention in time. His stream was inhumane. I ask for their record to be put into the order. Now we recognize mr. Rodgers for an hoping statement. Thank you again for granting our request to use the committee room. Im too saddened by the loss of the children. The department is taking steps to improve migrant care but it is up to us to address the root cause of the problem. It mean thats we must fix immigration loopholes, we must provide resources to cdp and i. C. E. We must not encourage immigration to our border. And i hope that we will never have to hear of another tragedy at the border like what happened with these three minors. Im disappointed that some of the events leading up to the hearing. The commissioner should be here so we can hear directly from him. majority did invite the commissioner but we knew he could not participate. We have provided guidance and they have been forbid ton participate. They asked me to appear in personal before the Senate Committee on june 25th. I ask consent to insert commissioner morgans response to the chairmans invitation. In that letter morgan requested to appear before the committee in person. If we want productive hearings, i would urgent to the majority that we find time to hear from him in the next two weeks when were in dc. Further, getting to the bottom of those two deaths is something that this committee has worked together on. We voted unanimously to. The department for information on the deaths of felipe and it seems we got Additional Information from mexico. It appears they did not share the information with witnesses here today and who knows who else before ninforming the minority of its existence. The minority got it on july 12th. It is disappointing to partner with things like this and have them opportunity out to be partisan and less than a week before the hearing. Im also alarmed by the always information. Why would anyone need human tissue samples from a 8yearold little boy. I hope they shait is not true, if it is it is deplorable. There is no misconduct or man feasance in any of the actions of dhs or its employees surrounding their deaths. I understand that doesnt provide any political satisfaction, but that is the fact. If they shared human issues, it would mark an appalling new low for this committee and i hope that is not the case. We must remember that for months song refused to address the border crisis that precipitated these deaths. Record numbers of families and children crossed our border last year. Hundreds of thousands of migrants came across the once at the whims of the cartels and the human smugglers. Many some of abuse, assaults, and worse. Food and medicine was not provided. Many arrived in extremely poor health. But for months last year the majority refused to even acknowledge the problem going as far as calling it a manufacturing crisis. En after t even after the children died they said there was no crisis. Finally after months, the maj majority admitted that there was a hand it will. Unfortunately that was a stopgap measure. The Homeland Security advisory said until they take action, it is only a matter of time before another one occurs. I hope at some point that we can get off of the political messaging game to fix the loopholes that encourage parents to send their children on a dangerous and dead ly trek to or border. Thank you, i yield back. Thank you very much. Other members are reminded that Opening Statements may be submitted for the record. Always we will operate according to the giant lines laid out in our july 8th colloquy. Now we welcome our panel of witnesses. Our first witness is dr. F danaher. He is member of the hospitals Child Protection team. Also mediate tricks at harvard medical school. Second witness is dr. Roger a mitchell junior. A chief medical examiner. He is Board Certified in anatomic and pathology. He started the study of Forensic Science for the federal bureau of investigation. Dr. Mitchell is a graduate of the new Jersey Medical school. Our third witness is the honorable joseph. He was confirmed as the department of Homeland Securitys Inspector General. He previously served as a policy advisor for military and veteran affairs for the governors of arizona. He earned a ph. D in management. Finally, we have mr. Rebecca gambler. She joined in 2002 and currently leads work in Border Security and election issues. Without objection their full statements will be inserted into the record. Here is her full statement, she has five minutes. Good morning. Chairman thompson, Ranking Member rog jers and members of e committee. Im dr. Fiona dannaher. It is a privilege to be part of the u. S. Customs and Border Protections. As you know in december of 2018, they became the first Migrant Children without underlying medical conditions to die in u. S. Custody. One child died of septic shock which went into multiple organ failure. Another died from untreated influenza. Their deaths, as well as those of four other children in government custody between september 2018 and may 2019 underscore the deficiencies in a system poorly designed to protect the wellbeing of vulnerable children. Review of records makes clear that jacqueline and felipe both suffered painful deaths that could have been prevented by timely access to pediatric medical care. The children died of Natural Causes in both cases and there was no misconduct conclude id to be done by personnel. Death by Natural Causes does not mean death was inevitable. The great efforts that several agents went to to help the children does not about solve them for perpetuating systems for placing children at medical neglect. Cvp released a new directive in an of 2019 to ensure that all children got Health Interviews and medical screenings when in custody. However, many of the safeguards instituted under the guidance were stopped, and it is unlike they the provisions would have prevented their deaths. Children are not little adults. Their remarkable resilience can mask disease from those not trained to see it. But detention in substandard conditions places childrens very lives at risk. If children are to be detained in cvp facilities, it is incumbent on them to strengthen their medical infrastructure. Their deaths illustrate the need for democratic hurdles to be addressed. They also highlight the urgency of addressing conditions that spread. They need comprehensive medical screenings in their native language with pediatric experts and referral as appreciate to mediate trick centers. Those with underlying medical conditions should not be returned to the centers unequ unequipped to provide safe operation. Teams of agents working in remote areas must include the Pediatric Community and Border Patrol stations should be stocked with basic pediatric illness treatments. Independent oversight of the quality of medical provided to the detainees needs to occur regularly. The oig recapped they dont have the necessary medical expertise for the task. Given the under epidemic and the impending arrival of another influenza season, action must be taken now. So that other children do not meet similarly painful and preventable fates by in custody of the United States government. Thank you for your testimony. Now i recognize dr. Mitchell to summarize his statement. Good afternoon for chairman thompson. Im dr. Roger missional junior and i serve as the chief medical examiner of washington dc. It brings me no pleasure to review the cases. I have been asked to review the cases from the medical examiner perspective specifically from the postmortal findings, the cause, and manner of death. I have been studying deaths in custody for over 20 years. And were reminded of deaths like george floyd and rashard brooks. They are under a continuum that is like arrest related, prearrest related, and in custody and incarceration which is shortterm and longterm jail d detention. This committee had been tasked to ru view infant and child deaths for system centered recommendations. This is the lengs a child that was a preended on tapprehe a 105 degree fever. The initial laboratory and aupts fi autopsy findings are consistent with sepsis. Early treatment is critical. Based on the materials that i had to review, the cause and manner of death, and it is my opinion that the death was preventable. The actions taken by the Border Control agents seemed to be timely, but they lack adequate Human Resources and physical infrastructure to respond to medically fragile detainees, especially children. The initial medical questionnaire was provided by a licensed medical professor. In the next case, we know felipe was apprehended with his father at the u. S. Border. Say were detained at three different Border Patrol stations before he was known to be sick. He was found to have a temperature of 103. He was trance port today a local hospital, but he had to come back because of a worsening position. He suffered kpli cases of a flew viral infection. This bacteria was isolated and had an aggressive exo doxin. And a highly contagious bacteria that is in close quarters. This toxin leads to severe rapidly progressing pneumonia. Based on the review of the materials available, it is my opinion, but none the less a bacterial infection. The manner of death is natural. It is my opinion that this every crowding is a known condition and i believe they may have played a significant role in the infections there is many opportunities for life saving care. However if there was a licensed medical professional to care for this child, there may have been a more informed assessment for his ichgs at the hospital. So what are my recommendations . Enforce and control the population to protect against overcrowded. Utilize medical personnel. Accompany this initial assessment with a breer brief health screening. And dwon an on sight clinicalment by the ability to triage patients. Maybe seeing these patients move from Border Patrol station to border pa control station. And retraining our agents. In conclusion, immediate and timely action by a licensed, Trained Medical profession could have prevented the deaths of jacqueline and felipe. They are symptoms of a more extensive system that requires more improvement. Any system that is established by our government must have, at its core, the health and safety of all that come into contact with it. The cases of these children must remind us that deaths in custody are not just a criminal justice issue, but we must provide a timely, accurate Reliable Care in the streets of our cities, the jails of our counties and the prisons of our states. I appreciate the work that the committee is doing and i pray this hearing does not just provide an appearance of addressing the issue, but a true call to action with resolutions. It may beyond what is comfortable for some, but i believe it is attainable. Thank you, chairman thompson, im not available for any questions you may have. Thank you, doctor, for your testimony. Good afternoon, chairman thompson. Thank you for your work about children in custody. My testimony to will include a discussion about the investigations of the death of the two mie grandchildren in custody. The findings of our unannounced inspections of cvp fibacilities and a over view of our inspections, audits, and n investigations. No parent should to go through losing a child. Im a parent and a new grandparent myself and i find that that is heartbreaking. They died within 18 days of each and less than 100 miles apart each case was unique. The cope of both investigations was to determine the stances of the inkes i did deaths of the children including any former misconduct by cvp personnel. We dead cased multiple important staff and we were ughments by cvp in one case. We conducted 44 interviews between the two investigations, neither investigation found min conduct or malfeasance. In fact both investigations determined the employees involved exhibited great concern for the childrens welfare and got medical treatment without delay. Cvb had a surge in families and unaccompanied children. And a pry he needsed more thanu fy19 than in any four fiscal years. Our office has conducted unannounce unannounced visits with cbds transport and search standards known as the t. E. D. Standards that can be observed and evaluated by our inspectors without specialized Law Enforcement or medical training. We summarized our 2019 unannounced inspections. Medical coverage varied by facilities. The facilities we did visit generally met the t. E. D. Standards for access to medical care. Containing the spread of contagious diseases. We have initiated an audit of policies and procedures for handling medical intervention and detention. We observe more overcrowding and recommend dhs take steps to alleviate it. There were two additional recommendations made related to telephone access to unaccompanied children. Dhs is on track to holding beyond the 72 hours we also initiated a review which is ongoing to identify the key factors contributing to prolonged cbp p