ICE/DHS: Jay Brooks, Liz Herskovitz, Mark Lenox, Joh

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Role of the Binational TB Card for U.S.
Immigration and Customs Enforcement Detainees

• U.S.-Mexico Binational TB Case Management and
  Referral Program Meeting
• April 4, 2005
• El Paso, TX
• Division of Immigration Health Services

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Division of Immigration Health ServicesMission

• We protect America by providing health care
  and public health services in support of
  immigration law enforcement.

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Program Objective

• Facilitate continuity of tuberculosis (TB)
  therapy for U.S. Immigration and Customs
  Enforcement (ICE) detainees following custody

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ICE Detention and Staging Facilities With on-site
DIHS Medical Facilities
Tacoma, WA
Batavia, NY
Queens, NY Elizabeth, NJ
San Pedro, CA L.A. Staging
Florence, AZ
El Centro, CA San Diego, CA
El Paso, TX
Houston, TX
Miami, FL
Pearsall, TX
Port Isabel, TX
Aguadilla, PR
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Average Daily Total ICE Detainee Population by
Year, 1993-2004
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Source DIHS Source U.S. Centers for
Disease Control and Prevention
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Detention-Specific Issues

• Frequent movement
• Intake, transfers, releases, repatriations
• Use of contract facilities
• Distrust
• Providers perceived as being associated with ICE
  officials
• Reluctance to provide contact and locating
  information

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Detention-Specific Issues

• Medical Holds are essential
• Collaboration with ICE and detention authorities
  is essential
• Medical holds recognize in detention file as
  well as in medical file
• Communication between medical and detention staff
• Language
• Need for interpreters or bilingual staff
• 150 language groups represented
• Significant paperwork burden / ancillary duty

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Site-Specific Approaches

• Florence detainee brought directly to medical
  for TB Card program enrollment following release
  from airborne infection isolation
• Requires ICE collaboration and incorporation into
  local detention facility processes
• Enrollment of TB Suspects, treatment not
  initially indicated
• Florence All TB suspects given card
• Tacoma Collect locating/contact information
  forward to CureTB if cultures later return
  positive no card given

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TB Suspects

• Smear positive, or treatment indicated
• Binational TB Card given
• Smear negative, treatment not initially indicated
• Detainees released before culture results
  reported to provider (any country)
• Active TB cases 18/73 (24.7)
• TB suspects 19/68 (27.9)
• Non tuberculous mycobacteria 4/17 (23.5)
• Status as of December 2004

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Challenges

• Differing case definitions U.S. and Mexico
• Differing criteria for initiating and continuing
  therapy
• Release/repatriation before case confirmation is
  available
• What do we do about nonadherence?

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Acknowledgements

• DIHS Staff at pilot sites
• Florence, AZ Stacey Dawson, Geri Tagliaferri,
  Eddie Frazier, Melissa George, Elizabeth Fleming
• San Diego, CA Erica Graham, Rebecca McTall,
  Steve Gonsalves, Dave Lusche, Joel Johnson,
  Gerard Bazile
• El Paso, TX Gina Chacon, Angel LaSanta,
  Elizabeth Escalera, Diane Aker, Erik Hierholzer,
  Rosa Colon
• Port Isabel, TX Wanda Gonzales, Dan Hankes,
  BuJean Jenkins, Jeri McGinnis, Luz Peredo-Berger
• Tacoma, WA Michael Tartaglia, Benford Bennett,
  Deanna Gephart, Phil Farabaugh
• Director Gene Migliaccio
• Deputy Director Geralyn Johnson
• Medical Director Tim Shack

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Acknowledgements

• DIHS Gene Migliaccio, Geralyn Johnson, Diana
  Schneider, Tim Shack, Sara Newman, Christine
  Williams, Steve Wacha, Denise Williams, Diane
  Aker, Kirsten Warwar, Andrew Hickey, Jim Sorenson
• ICE/DHS Jay Brooks, Liz Herskovitz, Mark Lenox,
  John OMalley, Christina Hamilton, Joan
  Lieberman, Michael Biggs, Mike Caltabiano, Tim
  Perry, Victor Cerda
• CDC Ron Valdiserri, Ken Castro, Mark Lobato,
  Kayla Laserson, Sue Maloney, Phil LoBue, Leslie
  Page-Taylor, Phyllis Cruise, Stephen Waterman,
  many others
• State/local HDs Sara Royce, Charles Wallace,
  Cheryl McRill, Ellen Murray, Kathy Moser, Anne
  Cass, Kathie Sullivan-Jenkins, David Ashkin,
  Alberto Colorado, Francisco Velasco, Leticia
  Browning, Jamie Kokko, Elena Torres, Maria
  Rodriguez
• MCN Jeanne Laswell, Del Garcia, Ed Zuroweste,
  Bertha Armendariz
• DHHS/OGC Jocelyn Mendelsohn, Esq.