Is an Asylum-Seeker’s Diabetes Being Dangerously Mismanaged?

A human rights organization and an immigrant rights group have organized a campaign to call for the release of an asylum seeker with diabetes from a Texas detention center out of concern that her insulin regimen is being dangerously mismanaged.

Grassroots Leadership and American Gateways are calling for the medical release of Brenda Menjivar Guardado, a woman from El Salvador who is seeking asylum and is being detained at the T. Don Hutto Detention Center in Taylor, Texas. Advocates say that Menjivar Guardado’s blood sugar levels are out of control and that she should be released to a medical facility.

In interviewing the advocates, it’s clear that there are several questions surrounding both Menjivar Guardado’s diabetes and her diabetes management at the facility. Those questions are hard to answer because her medical records have not been released to her advocates and Immigration and Customs Enforcement (ICE) has not met a deadline for an interview with Insulin Nation on her case. However, if the situation her advocates are relaying is accurate, Menjivar Guardado’s glucose levels are chronically high and she is suffering physically because of it.

Menjivar Guardado approached advocates about her case during a recent “Know Your Rights” seminar held at the Hutto Detention Center, a Texas facility which houses mainly women, including many whom have crossed the border without documentation seeking asylum in the United States. She told advocates she came from El Salvador with Novolin insulin, and she was allowed to keep her medication when she was detained by U.S. Customs and Border Protection in Texas. When she was transferred to ICE custody, however, she says her medication was thrown away.

Once in ICE custody, she has been receiving five injections a day and received information that said she was receiving Lantus and Regular insulin injections. However, she says the insulin regimen she is receiving is not controlling her blood sugar levels. As evidence, she presented her blood sugar log, which showed levels consistently between roughly 200 mg/dL and 450 mg/dL, with only two readings below 200 mg/dL, according to American Gateways lawyer Whitney Drake. She has complained of blurred vision, lost weight, and shortness of breath, Drake said.

“She’s aware that her body is not responding to the insulin,” Drake says.

On June 23rd, Drake filed a request for Menjivar Guardado to be released from ICE custody on medical grounds. That request was denied, and Drake has filed a motion asking officials to reconsider. Menjivar Guardado told advocates that after the first request was filed she was led into a room with four ICE officials and told she was not being noncompliant in her medical care. During that meeting, she says she was forced to drink four glasses of water in succession.

“She felt intimidated and confused by the interaction, to say the least,” Drake says.

Again, ICE has not granted an interview request by the time of the publication of this article.

Menjivar Guardado’s non-medical advocates freely admit that they don’t have much working knowledge of insulin-dependent diabetes, and that gap in knowledge shows in how they discuss her insulin regimen. It’s believed Menjivar Guardado has Type 1 diabetes, but that can’t be confirmed without medical records, for example. Also, it was not readily apparent in one interview whether an advocate understood that Lantus would typically be considered a step up in insulin brands over Novolin, for example. Also, no one has yet gotten her consent to have her medical records released. However, advocates also say Menjivar Guardado has only received information that she is taking Lantus and Regular; she apparently hasn’t seen the vials themselves.

Robert Painter, director of pro bono legal programs for American Gateways, admits that they don’t have a way to verify the health status of those who come to them with concerns like those that Menjivar Guardado expressed. However, Painter says he’s heard of many complaints of inadequate health care at the facility, mainly concerning mental health care. Menjivar Guardado’s case is the most serious Painter has heard of, and he believes what she is saying is true.

“Everybody who goes into that facility would like to leave that facility,” Painter said. “I’ve never seen someone personally lie about their health as a way to get out.”

Anita Jones is a Austin-based RN Family Nurse Practioner who met with Menjivar Guardado at the facility, but who has not had access to her medical records; she has been shown the detainee’s blood sugar logs. She says that the insulin that is being provided should be doing a better job controlling Menjivar Guardado’s blood sugar levels than the results shown in the log. She described how Menjivar Guardado expressed confusion about diabetes management procedures there, and wondered if there is some form of communication breakdown occurring between Menjivar Guardado and the staff. She believes the detainee’s insulin regimen needs to be adjusted by a medical provider over a number of visits, and she would like to volunteer as an advocate during these medical visits.  If there’s a problem with Menjivar Guardado’s diabetes management, they shouldn’t wait to address it until her appeal for reconsideration of release is decided, Jones said.

A note from Brenda Menjivar Guardado which reads, “Help me please I don’t want to be here I don’t feel good at all, my health is not good.”

In past, there has been unrest at the Hutto Detention Center because of conditions at the facility. In 2015, multiple media outlets reported that somewhere between 150 and 500 women detained there went on hunger strike. It is unclear from those reports if any demands were met as a result of the hunger strike.

ICE handled more than 235,000 deportations in 2015. The agency says it handles, on average, 545 health screenings, 239 physical exams, and 347 sick calls a day. Inevitably, some of those detained die in custody. Details of their deaths are not always made public, but can sometimes be obtained through a Freedom of Information Act (FOIA) request.

One such request found that 172 detainees died in ICE custody from October 1st, 2003 through June 5th, 2017. Diabetes was listed as the final cause of death in only two of those 172 deaths. However, diabetes is not often listed as a cause of death in many cases with coroner reports and death certificates.

The ICE FOIA library lists 18 individual reviews of deaths of detainees in ICE custody; a review of those 18 cases found two additional deaths where the individual in custody had diabetes. Those fatality reports sometimes fault inadequate care or failure to follow procedure among ICE medical and detention staff. Another detainee with diabetes died in ICE custody shortly after the ICE report cutoff date, according to a New York Daily News report.

Insulin Nation will provide updates on Menjivar Guardado’s case and continue to explore the issue of diabetes management in immigration detention facilities in the future.

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Craig Idlebrook is a past editor for Insulin Nation, Type 2 Nation, and Información Sobre Diabetes. He is now the community engagement and content manager for T1D Exchange.

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