Tanzina Vega: I'm Tanzina Vega, and this is a special podcast from The Takeaway. On this show, we've continued to cover stories of migrants who have died while in U.S. government custody, typically migrant deaths are shrouded in secrecy, making it difficult for attorneys, government inspectors or even journalists to find out what happened. But today, we bring you a new investigation, allowing the public to learn exactly what happened when a migrant died at one of the biggest immigration jails in the country last summer. In July 2013, a 40 year-old Mexican migrant died by suicide in a privately run Immigration and Customs Enforcement detention facility. The migrant named Efraín Romero de la Rosa had diagnosed schizophrenia and killed himself after spending 21 days in solitary confinement at the Stewart detention facility in Georgia. In partnership with The Intercept, The Takeaway is releasing a new investigation on what happened at the privately run detention center. Takeaway Associate Producer José Olivares has been looking in to Efraín's death. José accessed hundreds of pages of records, dozens of photographs, 18 hours of internal security footage, and more than five hours of audio from witnesses and correctional staff. We found that staff may have violated numerous rules when it came to dealing with the detainee who was battling a severe mental illness. Our reporting shows how Efraín's mental health was rapidly deteriorating while in ICE custody. Regardless, correctional staff neglected to provide him with the treatment he needed and sent him to solitary confinement for prolonged periods of time. Efraín's story helps us gain insight into the tangled and opaque world of ICE detention. As the Trump administration continues to round up migrants at an increasing pace, more people diagnosed with mental illness will inevitably be placed in ICE detention. Today on The Takeaway, a special investigation from The Takeaway and The Intercept. We just want to warn you that some of the audio in this piece is disturbing and hard to listen to. José Olivares reports.

Unidentified speaker: 911 emergency.

Unidentified speaker: Umm... We need EMS for one of our detainees... ummm.. He has hanged himself.

Unidentified speaker: OK, is he breathing?

Unidentified speaker: We're actually not sure. Ummm.. the nurse is down there now. It looks like they're doing CPR.

José Olivares: It's July 10th, 2013. An immigrant detainee is found hanging in his cell. It's 10:34 p.m.

Unidentified speaker: They're doing CPR.

Unidentified speaker: Yes, ma'am.

Unidentified speaker: They're doing CPR, Chris.

José Olivares: While awaiting deportation to Mexico, 40 year-old Efraín Romero de la Rosa died inside the Stewart Detention Facility. It's a sprawling privately run Immigration and Customs Enforcement jail located on the outskirts of Lumpkin, Georgia. It's operated by CoreCivic, one of the largest private prison companies in the U.S. Efraín was mentally ill and diagnosed with schizophrenia and bipolar disorder. He was found in his cell after spending 21 days in solitary confinement. Over the course of 11 months, The Takeaway set out to learn the details of Efraín's detention in ICE custody and what really happened on the night that he died. Since May of 2017, four Stewart Detention detainees have died: two by suicide, including Efraín. Neither ICE nor CoreCivic were able to provide more details on their Efraín's death or the correctional staff involved. But they both stressed that the safety and security of the people in their custody are their highest priority. Efraín was from the state of Puebla in the central part of Mexico. In 2000, he left his parents and his family and traveled north to the U.S., crossing the border into Arizona. He was in his early 20s, but his legal status made it difficult to find the type of work he wanted.

Isaí Romero: When he first got to the U.S., the type of job he sought was sales. But like everything here in the U.S., working in sales is really difficult.

José Olivares: That's Isaí, Efraín's brother, speaking to The Takeaway shortly after Efraín's death last summer.

Isaí Romero: He told me that when he first got here, he barely had enough to eat. But he liked working in sales and worked and worked.

José Olivares: But not long after arriving in the U.S., Efraín got in trouble with law enforcement. In 2004, while living in Virginia, he was charged with carjacking, possessing burglary tools and driving under the influence. He was found guilty and served time in a Virginia prison. It's unclear when Efraín was released, but he shows up on official records again in 2017 when he was admitted to a mental health institution run by the state of Virginia. According to the discharge sheet, Efraín was diagnosed as suffering from schizophrenia and bipolar disorder and was prescribed five different medications.

Isaí Romero: I would see him shake sometimes. Yeah, but, but with time, that sort of went away, Efraín was a bit calmer. Sometimes these types of illnesses can make you scared. But no, no, he was calm, calm.

José Olivares: Six months later, Efraín was arrested for larceny and was taken to jail at the Wake County Detention Center in North Carolina, and that's when Efraín encountered ICE. An ICE officer based at the Wake County jail discovered Efraín's undocumented status and determined that he should be detained while awaiting a hearing with an immigration judge. On March 13th, 2013, 40 year-old Efraín, suffering from diagnosed schizophrenia and bipolar disorder, was taken to the Stewart Detention Facility. Stewart is run by one of the largest private prison companies in the U.S., CoreCivic. And it's massive. It's the largest ICE facility in the country, housing only male migrants, including both those who have requested asylum and those who are set to be deported. According to housing plan documents The Takeaway reviewed, Stewart has the capacity to hold around 2,000 detainees.

Ranjana Natarajan: The detention center where Mr. de la Rosa was detained has a history.

José Olivares: That's Ranjana Natarajan. She's a clinical professor at the University of Texas School of Law, where she directs the Civil Rights Clinic.

Ranjana Natarajan: That history is one of providing inadequate mental health and medical care, as documented by numerous advocacy groups for a number of years. So I think you have a persistent problem with Stewart Detention Center, in terms of their inability to provide medical care and specifically mental health care to the people in detention, both as a result of not having enough staff, not having the right staff, not having properly qualified mental health professionals, as well.

José Olivares: This year, the International Consortium of Investigative Journalists published a groundbreaking investigation of the use of solitary confinement by ICE. They reviewed more than 8,400 reports of solitary confinement placements and found that staff regularly used the practice to punish migrants for minor offenses, sometimes for weeks or months at a time. And a recent report from the Project on Government Oversight found that in more than 600 solitary confinement reports they reviewed, roughly 40 percent of detainees had a mental illness. Although solitary confinement for mentally ill detainees is not prohibited by ICE, it is discouraged. In a 2013 directive, ICE warned that solitary confinement could cause the deterioration of medical or mental health.

Terry Kupers: People who are isolated, and that is nearly 24 hours a day in a cell, start developing a number of symptoms which get worse over time.

José Olivares: That's Terry Kupers, a professor at the Graduate School of Psychology at the Wright Institute.

Terry Kupers: The symptoms include massive anxiety, which may take the form of panic attacks, disordered thinking, which may take the form of paranoia. They become progressively more angry. The rate of suicide in solitary confinement is very high. Despair is very prominent. People become very depressed, and that often leads to suicide. So it's just a very miserable situation.

José Olivares: In a 2017 report from the Department of Homeland Security Office of Inspector General documented a number of detention center violations at the Stewart facility, including officers misuse of solitary confinement. Between July of 2017 and mid-March of this year, there were over 300 medical emergency calls of all kinds from the facility. That's nearly six times the number of calls as the ICE Adelanto detention center in California, which has a similar detainee population. In the hundreds of calls from Stewart's, there were four clear instances of mental health emergencies, including a call from this January reporting that a detainee had cut himself and was bleeding badly. One of the most well documented cases of suicide in detention happened at Stewart in May of 2017. Jean Jimenez Joseph was a 27 year-old DACA recipient set to be deported after he was arrested for motor vehicle larceny. He hanged himself after spending 19 days in solitary confinement. And the warning signs were all there, with Jean having repeatedly requested more medication and help in the weeks preceding his suicide. The night he died, a CoreCivic correctional officer neglected to look into a cell during the periods required by ICE, and he falsified logs.

Ranjana Natarajan: It's really incumbent on ICE to audit facilities where there are suicides that happen one after another, as we see in Stewart. I think it's really important that ICE audit the particular suicides, but also audit to see what are the systemic failures at the facility that are causing suicides to happen over and over again because we shouldn't be experiencing these kind of fatalities in immigration detention. Period.

José Olivares: Ranjana Natarajan says Jean's suicide at Stewart should have been a wake-up call.

Ranjana Natarajan: The fact that you see a suicide like Mr. de La Rosa's about 14 months after another suicide shows that perhaps there was not a thorough audit, a review of the procedures used at Stewart, because if there had been, then the suicide prevention should have been stronger by the time we got around to Mr. de La Rosa's case.

José Olivares: Back at the Wake County jail in February 2013, ICE noted Efraín's mental health condition.

Andrew Free: A federal immigration officer who happened to work for the county saw Efraín's mental health history and made a note that this person is not clearly in good mental health. This person is a person who has previously been identified as schizophrenic and will need immediate intervention upon his arrival at Stewart.

José Olivares: That's Andrew Free and the immigration attorney working with her Efraín's family. He's also representing other families whose loved ones have died in ICE custody, including Jean Jimenez Josephs. On March 13th, ICE took Efrain to the Stewart detention facility.

Andrew Free: The fact that the ICE officer identified and said out loud to the agency this person has schizophrenia should have triggered a process by which there's an evaluation, there's a determination as to the appropriateness of continued custody, there's a determination as to the appropriate location where this person's freedom is going to be deprived, whether it is Stewart or whether it's going to be the mental health hospital he was ultimately referred to. And there should be a determination as to whether this person is actually competent to proceed in immigration proceedings.

José Olivares: Two weeks after he got to Stewart, despite knowing about Efraín's mental health condition, staff placed him in solitary confinement for 15 days. Georgia state investigators told The Takeaway that the records indicating why Efraín was placed in solitary were marked as confidential by ICE and were not subject to release. Here's psychologist Terry Kupers again.

Terry Kupers: People who are prone to mental illness or already have a mental illness, their mental illnesses is exacerbated, psychotic, if they're schizophrenic, schizoaffective, they're very likely to have a breakdown in solitary confinement. If they're bipolar, they're very likely to have severe mood swings, manic and depressive. And if they're depressed, they're very likely to get more depressed and perhaps commit suicide.

José Olivares: ICE denied Freedom of Information Act requests filed by The Takeaway for these records, citing a pending investigation.

Terry Kupers: You look at this, this 15 day stint for Efraín, and you see the beginning of a deterioration.

José Olivares: While he was in solitary, Efraín began refusing his medication, but six days after Efraín was released from solitary, he was placed on suicide watch. According to records, he told staff he was the Antichrist and would be, quote, dead in three days. And his mental health continued to decline. On April 30th, a social worker requested that he be taken to a mental health facility at the Columbia Regional Care Center. He was brought there on May 4th and stayed at that facility for more than a month. But on June 11th, Efraín was returned to Stewart to continue his immigration proceedings. According to ICE, a health specialist made note of his schizophrenia during the intake process. ICE facilities are required to provide medical screenings to identify any health conditions during intake. And for housing classification purposes, detainees with mental health conditions, including schizophrenia, need to be recognized as, quote, special vulnerability detainees. But copies of Efraín's June classification form, provided to The Takeaway show that correctional officers marked "No" on whether he had a mental illness. Family attorney Andrew Free again...

Andrew Free: Two people. It's not just a one-off, it's two people. It's the person who screened him first and then a supervisor who reviewed it, both working for CoreCivic, looked at his Efraín's record, looked at the things that we have in front of us and said, nope, no mental health issues here. He was literally coming back from a specialized psychiatric facility after having been transferred out of Stewart because of his mental health issues. And the form that they signed, two different CoreCivic employees signed, said he's fine, don't worry about it.

José Olivares: ICE requires accommodations, including special housing and frequent medical observations to those who are classified as special vulnerability detainees. Despite Efraín's misclassification, medical staff were required to provide him his prescription medication. But a few days after returning to Stewart, he began refusing medication for his schizophrenia, telling staff he didn't need it. Only a week after returning to Stewart, Efraín was sent to solitary for the second time for inappropriate behavior with a correctional officer. The following details came to light through an investigation on Efraín's death conducted by the Georgia Bureau of Investigations, or GBI. At first, a lawyer representing CoreCivic ask that the GBI denied the public access to the records. But New York Public Radio counsel helped us file an appeal, and we were able to access the records, photos, video and audio interviews from the GBI's investigation. On June 19th, Efraín approached the correctional officer named Tylicia Lane and acted as if he were going to touch her inappropriately. Lane recounted the story to the investigators.

Tylicia Lane: He just kept saying he was going, he like me, I'm beautiful, and he try and touch me...

José Olivares: A supervisor at the facility, decided to punish Efraín. Andrew Free again.

Andrew Free: That is the disciplinary report that ultimately put Efraín in the tomb where he would die.

José Olivares: The punishments, 30 days in solitary confinement, the maximum amount of consecutive time allowed by ICE standards. According to ICE, a nurse cleared Efraín for solitary. But in the disciplinary pages The Takeaway examined, correctional staff made no mention of his mental illness when punishing him, a probable violation of ICE standards.

Ranjana Natarajan: When you place someone who has mental health needs and who perhaps has not been taking their medication, has auditory hallucinations, has a history of self-harm, what you're doing is is radically increasing the risk of suicide, especially if you put them in a jail cell that also has protrusions that they can use to readily hang themselves.

José Olivares: That's Ranjana Natarajan again from the University of Texas School of Law. The Takeaway reached out to Latoya Gaynor, the disciplinary officer who sent Efraín to solitary for 30 days without recognizing his mental illness. We never got a response. The isolation cell was tiny with a bunk bed, a chrome toilet and sink and two concrete shelves. Every day, Efraín spent 23 hours in the cell with only one hour allotted for recreation time. GBI audio records provide a window into Efraín's experience in solitary.

Jorge Caballero Ramos: We saw him sat all of the time. We saw like just walking around every night and he don't talk with nobody and we saw him just pushing the door sometimes, pushing the door sometimes, and, you know, these people, they don't pay attention they don't care.

José Olivares: That is Jorge Caballero Ramos, another detainee in the solitary unit who told investigators what he saw. Detainees can communicate by yelling through the walls of the solitary unit and can see each other during their one hour of recreation.

Jorge Caballero Ramos: And he talk sometimes, he say, take me out, want to be here my family, take me out, I want to be here, my family. That's what I hear he talk. Because he no talk to nobody. He just say that loud.

José Olivares: On the top bed, Efraín kept the Santa Biblio, a Spanish language version of the Holy Bible. Penciled scribbles covered the bottom side of the bunk bed and parts of the wall. One read, "Cada día es mas importante." Each day is more important.

Jorge Caballero Ramos: We already know something has happened to him because he looked worried and he always crying, he always crying. This guy over there, he always crying. You can ask everybody he always was crying, but they don't care.

José Olivares: After 21 days in solitary on the morning of July 10th, 2013, a social worker filed a report noting that Efraín, quote, would benefit from a referral to a higher level of care mental health facility. No immediate action was taken. That night at 4 p.m., Efraín turned his lights off, which struck Caballero Ramos as odd.

Jorge Caballero Ramos: Turn the lights off early. Yeah. He turned the lights off early and they know, and they saw. That's not normal.

José Olivares: So he attempted to alert the correctional officer on duty that night.

Jorge Caballero Ramos: And we told him something is happening. We told him. He can told you. We told him. Can you check him? And they don't, they don't even care. You can see they didn't even care.

Unidentified speaker: Sir, what's your last name?

Rodney Dent: Dent. D-E-N-T.

Unidentified speaker: First name?

Rodney Dent: Rodney.

Unidentified speaker: What's your title here?

Rodney Dent: Detention officer.

José Olivares: Rodney Dent was the officer assigned to Solitary Unit 7B that night. Detention centers require staff to look inside every single solitary confinement cell every 30 minutes and to sign off every time they do these rounds. Here's Ranjana Natrajan again.

Ranjana Natarajan: The whole purpose of jail and detention officers doing rounds is to directly observe the inmate to make sure that the detainee is breathing, to make sure that the detainee is moving. Even with a sleeping detainee, what the guard or the officer is supposed to do is to observe them until they see their chest rising and falling to make sure that they are not in some critical state of of alarm, that they are doing OK.

José Olivares: And that was the job of Correctional Officer Rodney Dent. Dent told investigators that at 10 p.m. he looked into Efraín's cell.

Was the light on or off?

Rodney Dent: He had the nightlight in the room.

Unidentified speaker: OK. Nighlight on. Was it lit up? You could physically see him then?

Rodney Dent: I just saw a silhouette of his face.

Unidentified speaker: OK

Rodney Dent: And his gold tooth in his mouth and a smile. He waved at me.

José Olivares: Dent says that when he looked, Efraín smiled and waved at him. But what actually happened is much different from Dent's account to the GBI. These findings were first reported by the Atlanta Journal Constitution based on internal CoreCivic reports. The Takeaway accessed 18 hours of security camera footage in order to verify the CoreCivic report's findings. According to the surveillance video, the last time Dent looked into the cell was at 8:40 p.m. From then until the end of his shift, Dent signed the paper next to the cell door without looking inside.

Ranjana Natarajan: If the guard or the officer never even looked into the cell to see what Mr. de la Rosa was doing and if he was breathing, he wasn't doing his rounds. That's not doing an observation at all. That's a critical failure.

José Olivares: In that time that correctional staff didn't look, Efraín tied his socks together, attached them to the top of the bunk bed and hanged himself. The Takeaway reached Rodney Dent by phone in April. He said that what happened that night was a bad experience that he's trying to leave in the past. He then hung up the phone. At 10:30 on the night of Efraín's death, nearly two hours since someone checked on him, a new correctional officer began his shifts looking into the cells. That was Jemorris McCoy. Here's what he told the GBI.

Jemorris McCoy: I went to 105 where he was at. I hit one up though I noticed he wasn't responding. It was just about 10:33 going on 10:34. I hit him room up one or two time and he ain't respond so l called a medic emergency and arrived 10:34.

José Olivares: McCoy saw Efraín hanging from the pair of orange socks and radioed a medical emergency. The officer working the other solitary units rushed over. They got a tool and cut everything down. Then Jamal Williams, the supervisor for the night, also rushed over.

Jamal Williams: See he had a, it was a sock, a sock wrapped around his neck. Myself and Officer McCoy lifting him up, you know, to relieve the pressure off his neck. Officer Blue used the suicide knife to cut him down. We laid him down flat on the ground there. Officer McCoy immediately began CPR.

José Olivares: The Takeaway accessed handheld camera footage from that night. Correctional staff start recording for liability purposes. Some of this audio is upsetting and difficult to listen to.

Unidentified speaker: Breathe, breathe... [banging, yelling]. Tired? Little bit tired? Yeah, Buzz, take over for him, take over...

José Olivares: You can hear dtainees banging on the cell doors, yelling at correctional staff while McCoy performed CPR. The nurses begin to arrive.

Nurse: Call the meds now. Get the AED. AED. Is it in here? Where is the AED?! I need a stat! Now. Get the AED. Hey, buddy, can you wake up for me? Wake. Hey! Come on, buddy. Come on. Hey, hey. Wake up for me. Hey. Come on. Please. I need an oxygen. There was nothing on my cart.

Jamal Williams: Beyond that, he was already dead.

Jorge Caballero Ramos: The ambulance come, all the officers come. But they can't do nothing. He was already dead.

Nurse: Come on, buddy, come on. Please. I need an AED. I need some nurses up here! Please tell them from intake to come up here, have some nurses come up here stat.

José Olivares: According to reports from the GBI and CoreCivic and audio from detainees and staff, the facility seemed to be underprepared to respond to the suicide. The senior detention officer assigned to the medical unit did not hear the medical emergency call because her radio was dead. The first oxygen tank medical staff brought over to the scene was out of oxygen and the automated external defibrillator, or AED machine, was not immediately available.

Ranjana Natarajan: I think it's a critical failure if lifesaving devices like the AED and the oxygen tank are not available.

José Olivares: The ambulance arrived at 10 45 p.m., 11 minutes after Efraín was found. They put him on a stretcher and rushed him to the hospital.

Unidentified speaker: Now he's still, he's clinically dead right now. We're doing everything we can to reverse that.

José Olivares: A doctor pronounced Efraín Romero de la Rosa dead at 11:29 p.m. The Takeaway reached out to ICE for the story. An ICE spokesperson said that fatalities in ICE custody occur approximately 100 times less often than they do in both federal and state custody nationwide. An agency spokesperson was unable to give more specifics on Efraín's death and redirected our questions to CoreCivic, saying that ICE couldn't speak for the actions, of CoreCivic staff. When we reached out to CoreCivic, a company spokesperson told us the company couldn't comment on Efraín's case because it was still under investigation by ICE. But that, quote, the safety and well-being of the individuals entrusted to our care is our top priority. The spokesperson noted that ICE, not CoreCivic, was overseeing health care at the facility. The Takeaway accessed hundreds of internal records as part of this investigation. These records reveal that ICE Health Service Corps was in charge of health care at the facility, but had also contracted three different companies for health care services-- Maxim Health Care, InGenesis and STG International, Inc.. Maxim said their contractors received thorough training from ICE and that no Maxim workers were involved in Efraín's case. Although it is true, no Maxim nurses responded on the night Efraín killed himself, the company did not say whether it was involved in his case in the weeks preceding his death. InGenesis said that it is committed to staffing trained and qualified personnel for health care purposes and then redirected our questions to ICE. STG did not respond to multiple requests for comments and a long list of questions detailing our reporting. No single agency or company has taken responsibility for Efraín's death. Since his death, there have been some changes at the Stewart facility. Stewart has a new warden now. Stewart's previous warden was Charlie Peterson, and CoreCivic told us his departure was unrelated to Efraín's death. When we reached out to him, he refused to speak with us, saying he was not allowed to speak with the press. CoreCivic also said that Rodney Dent, the officer who did not look into Efraín's cell, was fired. Healthcare at the facility has also changed. Last November, ICE ended its contracts with the three companies that helped manage health care at the facility, and ICE Health Service Corps is no longer operating in the facility. An agency spokesperson said that ICE contracted all healthcare work at Stewart to one single company, that company CoreCivic. Despite two detainees dying by suicide in less than two years, under the custody of CoreCivic staff, ICE gave them the healthcare contract anyway. Efraín was not sentenced to death for crossing the border almost two decades ago, but by being placed in ICE custody with a mental health condition, that was his fate. Ranjana Natarajan at the University of Texas School of Law believes that Efraín's death could have been prevented.

Ranjana Natarajan: People with very serious mental illnesses often do not need to be in ICE detention, especially because they're going to end up in segregated housing for low level disciplinary violations, and then, the risk of self-harm and suicide increases once they get into that segregated housing.

José Olivares: If officers and healthcare staff followed every rule in the book, would Efraín still be alive today? That question is difficult to answer. Andrew Free, the attorney for Efraín's, family, places blame squarely on the system.

Andrew Free: What it is, it's detention itself. When you have this bias toward putting human beings in cages, in order to get them through a civil immigration detention hearing without fighting, without having counsel, without having an access to a lawyer or a community advocate who can help them win their case, because you want to up deportation numbers, because you want to racially profile and ethnically cleanse the United States of people you find undesirable. And when you have this profit motive that fuels that, it is, it is a system that sets people up to die.

José Olivares: For Efraín's brother, Isaí, blame is not the answer.

Isaí Romero: I want there to be more noise, more anger so that this death won't be in vain. If we can, with my brother's death, I want other Hispanics to open their eyes, for there to be more unity among us, so we don't fall and become accustomed to injustice. Because sometimes if we are quiet, that's what they do to us, what they do. So that's what I hope for, for there to be justice.

Tanzina Vega: That was Takeaway associate producer José Olivares, and you can read the detailed investigation online by visiting thetakeaway.org and theintercept.com. There, you can also find an accompanying film by the Intercept's Travis Mannon and Lauren Feeney. A special thank you to Cindi Kim, Associate General Counsel here at New York Public Radio. For The Takeaway-- Deidre Depke, Ellen Frankman, Lee Hill and Arwa Gunja edited the audio piece. Jay Cowit sound designed and composed the score. And for The Intercept, Ali Gharib edited this story and Ariel Zambelich visually designed it. I'm Tanzina Vega, and this has been a special investigation from The Takeaway and The Intercept.

 

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