When Amy Pacheco took the temperature of the fatigued, feverish pregnant woman — an asylum seeker spending the night at Casa Alitas’ shelter in Tucson — and saw 101 on the thermometer, she knew the woman could be at risk of miscarriage.
A Mexican citizen, the woman said she had been diagnosed with a urinary tract infection and prescribed antibiotics during her journey through Mexico, before crossing the border into Arizona and surrendering to Border Patrol agents along with her husband and young child.
Border agents confiscated her antibiotics. The family got a photocopy of a new prescription, indicating the agency had tried to replace the medicine. But before the new antibiotic arrived, the family was released from Border Patrol custody and transported to Casa Alitas as legally processed asylum seekers, said Pacheco, program coordinator for Casa Alitas’ migrant health-care program, which is run by the nonprofit Southeast Arizona Health Education Center, or SEAHEC.
Now, at nearly 9 p.m., Pacheco knew she had a small window of time to find a pharmacy that could refill the crucial prescription, before the family left the shelter at 6 the next morning. After that, it would likely be days or weeks before they’d connect with a new provider, she said.
It happens every day, according to medical workers at Casa Alitas: Migrants arrive in distress after border agents confiscate prescribed medications — including children’s asthma inhalers, insulin for diabetics, seizure medicine, and drugs for heart conditions or high blood pressure — leading to health complications, avoidable hospitalizations and costly treatments.
“It’s a constant issue,” said Gail Emrick, executive director of SEAHEC. “Medication being taken away by someone who’s not a health provider doesn’t make sense.”
Multiple times this year, asylum seekers have even reported having colostomy bags confiscated, Emrick said.
The Border Patrol often re-prescribes medications it has confiscated from migrants, but the replacement medications routinely arrive too late at Casa Alitas, after the migrant has already left, said Amy Pacheco, coordinator of Casa Alitas' migrant health-care program, which is run by the nonprofit Southeast Arizona Health Education Center, or SEAHEC. The re-prescribed drugs, which arrive in plastic bags labeled "Homeland Security," then must be destroyed, said Pacheco, pictured holding one of the bags in Tucson last week.
Routinely, the medications that U.S. Customs and Border Protection have re-prescribed show up at Casa Alitas too late, after asylum seekers have already moved on from the short-term shelter. Between April 26 and May 9 alone, it happened 60 times, Pacheco said, which is substantially less than in December, when migrant arrival numbers at the southern border were twice as high.
SEAHEC then has to pay to have the medication safely destroyed, in addition to costs incurred from re-prescribing missing drugs before asylum seekers move on to their final destinations, Emrick said.
“There seems to be an attempt on the part of CBP to want people to get their medication, because we are getting it, but we’re getting it after the fact,” Emrick said. “That’s a great waste of time and resources.”
After a March meeting with CBP’s acting chief medical officer Alexander Eastman about the issue, Emrick and Pacheco said they learned CBP doesn’t have a uniform policy across all border sectors on how to handle medications.
“It’s left up to each sector to apply whatever procedures they feel necessary in their sector,” Emrick said. “There’s no one common standard of practice.”
Eastman seemed open to finding solutions, but “noncommittal” in terms of specific reforms, she said.
Interview request denied
CBP officials denied the Arizona Daily Star’s May 10 request to interview Eastman, or another official familiar with the medications issue. The agency did not respond to written questions the Star submitted on May 16.
A CBP spokesman, speaking on background, said migrants’ medications are assessed at a soft-sided processing facility after migrants who crossed between ports of entry have been taken into custody. But CBP cannot let people in their custody take a medication unless they can verify it’s approved for use in the U.S., the spokesman said. If it can’t be verified, it must be replaced with a new prescription.
Providers at Casa Alitas have heard conflicting reports from migrants and CBP in terms of how prescribed medications are handled. Some migrants report that border agents take them away because “they say they’re not a hotel and don’t have room to store it,” Emrick said.
That doesn’t make sense when talking about products that can fit into someone’s pocket, like an asthma inhaler, she said.
“We’re putting people in potentially life-threatening situations, including children, for a provided reason that just doesn’t make sense,” she said. “It’s those kind of life-threatening predicaments that are unnecessary and dehumanizing. It’s very frustrating as health professionals to be spinning our wheels, trying to figure out, ‘Is this a policy? Is this a practice? And if it’s either, why?’”
Pacheco’s eyes filled with tears as she described sick asylum seekers who arrive at Casa Alitas “basically begging” for their medication, she said. Many feel reluctant to speak up at all while in CBP custody, and only reveal their medical distress once they get a chance to sit down with a provider at Casa Alitas.While in CBP custody, “they feel that they can’t speak up for themselves, even if it’s something as serious as, ‘I have a heart condition,’ or ‘I have diabetes,’” Pacheco said.
Casa Alitas has a close partnership with Border Patrol and its parent agency CBP, said Joe Liesz, development director for Catholic Community Services, which manages the Casa Alitas program.
“We know CBP is in a difficult position, needing to uphold U.S. laws regarding medications coming into the country, security concerns and the health needs of the legally processed asylum seekers they’re releasing to us every day,” he said in an email. “It’s not a perfect system, but we know they are trying to do the best they can with the resources they have and it’s getting better. We really appreciate the partnership we have with them and are looking for ways to improve how we can work together in this.”
CBP medical spending data elusive
Over the course of three weeks, CBP did not respond to the Star’s queries about how much it spends a year on prescriptions for migrant arrivals at the southern border, and its most recent budget presentation does not give a breakdown of medical spending.
Finding that spending detail through Freedom of Information Act requests would be a challenge, said transparency attorney Andrew Fels of Al Otro Lado, a migrant- and refugee-aid nonprofit based in California and Tijuana, Mexico.
“Information about federal contractor medical billing can be hard to come by, as it arguably falls within multiple FOIA exemptions,” Fels said. “Getting re-prescription data would likely be even more challenging” as that might not be tracked.
Fels is currently litigating a FOIA request seeking an overdue death-investigation report on a 52-year-old Cuban woman who died in CBP custody last year. Her family said she was on blood-pressure medications which shouldn’t be stopped suddenly and died about six hours after being taken into custody. Her family believes she had her medications with her, but they were not listed on her CBP medical intake form, Fels said.
CBP’s medical contractor, Loyal Service Government Services, as well as Eastman, are the subject of multiple whistleblower complaints raised before U.S. Congress and other oversight agencies, alleging failures in medical care at the border.
One CBP whistleblower said they raised concerns about Loyal Service’s performance more than a year prior to the May 2023 death of an 8-year-old medically vulnerable child, on her ninth day in CBP custody in Texas. The whistleblower thinks Anadith Danay Reyes Alvarez’s death could have been avoided if CBP had responded to those concerns, instead of firing him in retaliation, said Andrea Meza, director of advocacy campaigns for the nonprofit Government Accountability Project, which represents the whistleblowers.
“The immigration system is so opaque in terms of expenses and oversight generally and that, in our view, is why whistleblowers are so vital to oversight,” Meza said.
One of the whistleblower disclosures describes Loyal Service mishandling costly HIV medications after they were seized from migrants.
“If the noncitizen left CBP custody before the medication arrived, there was no clearly communicated policy regarding what to do with the expensive specialized medications, some of which cost up to $1,400. This resulted in disposal of these medications,” the
February disclosuresaid.
Gail Emrick is executive director of the Southeast Arizona Health Education Center, which runs Casa Alitas’ migrant healthcare program, known as CHAMPS.
In their meeting with Eastman, Emrick and Pacheco said they suggested migrants be allowed to keep their medicine until a medical provider at Casa Alitas, or other short-term shelters, can assess them.
Another possible solution could be for CBP to establish on-site pharmacies at processing centers, to reduce the delays from sending prescription requests to urban pharmacies hours away, said Dr. Belen Ramirez, family physician with global humanitarian-aid nonprofit Doctors Without Borders.
Ramirez recently led a four-week medical assessment at the Arizona-Mexico border, concluding a “humanitarian medical crisis“ exists there, due in part to asylum seekers’ lengthy exposure to the elements as they wait for border agents to pick them up in far-flung regions of the border.
The additional expense of creating a new pharmacy site would reduce the funds wasted on duplicated prescription refills, and unnecessary hospitalizations and treatments for migrants whose conditions worsened without their medications, Ramirez said.
“It’s money down the drain,” she said.
After hearing about the medical confiscation issue from Casa Alitas, Ramirez also met with CBP’s Eastman in mid-April, during Doctors Without Borders’ visit to Arizona.
“He was open (to finding solutions),” Ramirez said. “But at the end, it’s one thing to be open and it’s another thing to actually find a solution.”
“Please help us”
In the case of the pregnant woman with the high fever, Pacheco jumped into action. It was late at night, and she went to two pharmacies before she found one that was still open and could re-prescribe the antibiotic immediately.
At the south-side Walgreens, Pacheco told the night-shift pharmacist, “’I know you have many prescriptions to fill, but this lady is pregnant, she has a UTI and she’s not gonna be here tomorrow. She’s ill. Please help us,’” she recalled. “And thankfully, he did.”
Back at the shelter, now after 10 p.m., Pacheco woke up the sleeping woman and gave her a snack and water to take with her antibiotic. Pacheco said she knew that in a few days, a plastic bag would arrive, labeled “Homeland Security,” with the woman’s delayed antibiotic inside, and she’d have to throw it away.
Emrick said part of SEAHEC’s mission is advocating on behalf of vulnerable patients, and this is one issue where a solution seems within reach, if officials have the will to do it, she said. In the meantime, asylum seekers are suffering, including children who have had asthma inhalers taken away, she said.
“They’ve already passed through enough trauma, so having them be fearful that their kid’s not going to breathe because they’re having an asthma attack is just an unnecessary burden,” she said.
Sometimes medications are simply forgotten by busy agents, Pacheco said. She recounted one instance of waiting for a diabetic guest’s insulin to arrive at Casa Alitas. Soon before he was scheduled to depart Casa Alitas, a Border Patrol transport bus arrived. Pacheco ran over to ask the agent if any medications were on board.
“He said, ‘Actually, yes, thank you for reminding me,’” pulling out a small blue cooler with the medication, she recalled. Immediately afterwards, the asylum seeker, who was already feeling ill, took out the insulin and injected it, she said.
There has to be a better way, Pacheco said.
“We have to work together because it’s going to make everyone’s life and job, and helping others, much easier,” she said.Ramirez said Doctors Without Borders often works in war-torn, low-income countries. It’s frustrating to see preventable medical complications arise, due to haphazard use of resources, in a wealthy, developed country like the U.S., she said.
“The means are there. The funds are there. They are just not being used in an effective way,” she said. “I’m sure they (CBP) have other things to fix and other problems. But this should be a priority, because it can lead to consequences for the people.”
