Call with Office of Inspector General, Department of Homeland Security
Office of the Inspector General (OIG), Department of Homeland Security (DHS)
On Thursday, August 8, 2019, NAPNAP leaders had an opportunity to speak with key staff from the Office of the Inspector General of the Department of Homeland Security (DHS) to gain information on the inspections and other processes related to children at border facilities. The OIG is an independent agency of DHS that is tasked with protecting the integrity of the DHS programs. Specifically, its inspectors have oversight of inspections by Customs and Border Protection (CBP), and Immigration and Customs Enforcement (ICE) activity. Its role is to ensure that these facilities are in compliance with DHS core standards.
NAPNAP’s goal with requesting the dialogue with the IG office was to gather objective, unbiased information for our members, who are concerned with how to deliver healthcare to migrant children. NAPNAP leaders are pleased with the productive conversation with the OIG office, and its response to our letters, concerns and advice as a key stakeholder in pediatric healthcare delivery. NAPNAP had previously sent a letter to OIG offices in July 2019 to express our concern for children’s health and well-being while held in border facilities. NAPNAP shared first-hand accounts of NAPNAP members caring for immigrant children outside of the facilities. NAPNAP took the initiative to ask for the call.
NAPNAP leadership provided background on the education, clinical experience and collaboration of pediatric nurse practitioners and pediatric-focused advanced practice nurses. We highlighted the variety of clinic settings we practice in as well as our 50 chapters and areas of expertise. We discussed the history of NAPNAP as an association, our membership, as well as our unique view of holistic, preventative care with special attention to evidence on adverse childhood experiences. We discussed our leadership in pediatric education for advanced practice nurses and providing national child healthcare experts to represent the association in a number of venues. We also discussed the importance of NPs in meeting demands of healthcare of children throughout the country.
Ms. Diana Shaw shared that DHS OIG inspectors go to the facilities and ensure core standards are met with respect to access to medical care. The OIG office is not currently involved in assessing the quality of care or other aspects of care such as mental health. In addition, the OIG is not currently involved in any contracting process for medical services, which largely depends on funding and responsibilities of Department of Health and Human Services (HHS). HHS has subject matter experts on staff. The DHS OIG office is not able to evaluate the long-term health impact of detention of minors but receiving informative data from associations such as NAPNAP helps it in their inspections process.
NAPNAP leaders Cathy Woodward and Dawn Garzon Maaks shared their experiences in volunteering their time and previously speaking with legislators in Washington, D.C. Woodward shared her knowledge of the types of illnesses she has encountered and her concerns for the upcoming fall/winter seasons when there will be an expected increase in viral illness, including flu. Shaw shared that DHS OIG is concerned about flu season, as well as the health of the inspectors themselves. She is aware that the overcrowding and prolonged detention areas contribute to these concerns. She provided reassuring data that most children are currently being released from these border facilities within 72 hours, which should decrease risk for illness. The DHS OIG team can’t predict when there may be a surge of people/illness. Woodward inquired whether the screening tool being used was specifically for pediatric patients. We understood from the briefing that the sick children are monitored on a routine basis, but we were unable to determine by what type of professional and in what capacity. Everyone discussed the importance of all medication being kept with the child and the importance of documentation of any health encounter. Documentation provides continuity and clarity for patients that are being evaluated in practices after release from detention. Shaw shared that her team observed at one detention facility that children and families were told to identify valuables, after which their remaining property was confiscated and thrown away. It is possible that, for fear of disclosing illness, detainees may be throwing away needed medications.
The OIG shared information on its inspectors and process. Its group has approximately two dozen inspectors who have history working with CBP and ICE officials, demonstrating institutional knowledge of these groups. Its core standards of access to medical care include the CBP process for migrants during transfer, those requiring triage and emergency care, hospitalization, and any needed precautions to be taken. It is not responsible for evaluating the effectiveness of the process, but rather ensuring there is a process which place that can be observed objectively. If an inspector were to see a child in distress, the inspector calls attention to the child in real time.
Lastly, NAPNAP asked about follow up and continued awareness. Shaw shared that the best thing for members to do is to raise concerns via the DHS OIG hotline so information can be shared with senior executives. The OIG reviews these comments to provide oversight into next steps (audits, review, etc.). At this time, there is not an opportunity for NAPNAP providers to interact with inspector staff. However, its office has encouraged our leaders to keep open communication. A future call will be scheduled, if necessary. NAPNAP leaders thanked. Shaw and Mr. Jackson Eaton for their time and for hearing our perspective. It is a complex process of which OIG’s oversight and review is critical.