Denied Medication, AIDS Patient Dies in Custody (Immigration)

Victor Arellano's Fellow Detainees Staged a Protest Over His Treatment

By Sandra Hernandez

Daily Journal Staff Writer

LOS ANGELES, Aug. 9, 2007 - The handful of prescription drugs Victor
Arellano took each morning kept him alive.

But Arellano, in the throes of full-blown AIDS, was denied that
medicine when immigration officials locked him up at the San Pedro
detention center, other detainees said.

Two months later Arellano, 23, died in custody - too weak to walk to
the bathroom alone, but shackled to a hospital bed.

Arellano's family and his fellow detainees said the detention center's
staff denied him his critical medication despite repeated requests.

"He called me two weeks before he died and told me he was afraid,"
said Arellano's mother, Olga. "He kept telling me how frustrated he
felt because he wanted to see a doctor. He asked for his medicine but
no one listened to him."

Victor came to the United States from Mexico as a child. A transgender
person, he was known as Victoria Arellano to his fellow detainees, who
routinely referred to him as her.

"She was so sick that if you tried to move her she would scream," said
Walter Ayala, another detainee, recalling her final two weeks.

Arellano spent most days in a bunk bed, complaining of debilitating
headaches, back pain, nausea and stomach cramps, Ayala said.

"This is the most extreme case I've encountered in my research," said
Megan McLemore of Human Rights Watch in New York. She is preparing a
report, due out this fall, on HIV/AIDS conditions in U.S. immigration
detention centers.

"We have received a lot of complaints from detainees and their
advocates," McLemore said. "The complaints are about the delays in
getting medication and continuity issues where people get moved
around."

Three years ago, doctors at a Los Angeles free clinic said Arellano
did not require skilled nursing care and was asymptomatic.

She was prescribed daily doses of bactrim, a prophylactic antibiotic
given to HIV patients to prevent pulmonary infections from developing
into life-threatening pneumonia. Arellano was later switched to
dapasone, another antibiotic.

Arellano was still taking dapasone when she was sent to the San Pedro
detention center in May. Medical experts said taking HIV patients off
dapasone could produce deadly results.

"The consequences of taking someone off that medication is that within
a few weeks a patient may unfortunately develop pneumonia and then not
respond to treatment," said Homayoon Khanlou, chief of medicine for
AIDS Healthcare Foundation, the largest AIDS clinic in the U.S., based
in Los Angeles.

Arellano's mother said doctors at the San Pedro hospital said her
son's body was wracked by meningitis and pneumonia.

"We spend millions to ensure every single detainee is screened and has
access to medical care," said Marc Raimondi, a spokesman for
Immigration and Customs Enforcement, the agency that oversees
detention centers.

"A significant percentage of those that come into our care have
pre-existing conditions that we provide care for," said Raimondi, who
said he could not comment on Arellano's case. "A lot of times our
medical care is the first time they receive treatment for illnesses
they didn't even know they had."

An estimated 29,000 foreigners are held in U.S. detention centers, a
loose network of 400 jails, private facilities and federal detention
centers.

The medical system designed to help detainees was unable to keep
Arellano alive.

Arellano's final days were spent in a dormitory-style cell built to
hold 50 men but often houses as many as 80.

Arellano's care fell to fellow detainees, who soaked their bath towels
in water to cool her fever and used a cardboard box as a makeshift
trash can to gather her vomit.

"We all asked the guards for help, to take Victoria to the infirmary
but no one did anything," said Oscar Santander, a fellow detainee.

"The last week was the worst," Santander said. "She couldn't stand so
we took turns taking her to the bathroom. She was vomiting and had
terrible diarrhea."

Arellano was taken to the infirmary and on July 13 given drugs to
treat nausea and amoxicillin, an antibiotic, according to a
prescription signed by Jeff Brinkley, a senior nurse practitioner
assigned to the San Pedro detention center.

Medical experts said amoxicillin is not used to treat AIDS-related infections.

"It would not be my drug of choice because it would not cover the
problems or infections an HIV person would have, such as a lung
infection or meningitis," said the AIDS Healthcare Foundation's
Khanlou.

Arellano couldn't keep the drugs down and began vomiting blood, Santander said.

By nightfall, Arellano looked so pale and weak that 80 detainees
staged a protest, ignoring an order to get in line for the nightly
head count.

The men began chanting "hospital," said Abel Gutierrez, a Mexican detainee.

"She was so sick and they wouldn't do anything," Gutierrez said.

Arellano was taken by ambulance to a San Pedro hospital. Less than 24
hours later, she was back in the detention center, crippled by intense
vomiting and bouts of diarrhea.

Arellano was again rushed to the hospital.

This time, Arellano was taken to Little Company of Mary Hospital's
intensive care unit, where she died July 20, shackled to a bed with
two immigration agents standing guard at the hospital room door.

Raimondi said 62 immigrants, including Arellano, have died in federal
immigration custody since 2004, three at the San Pedro center.

In 2000, federal immigration officials adopted medical standards.
However, those standards are not legally enforceable, unlike those for
inmates in state or federal prisons.

"The fact is there is no legal recourse for immigrants in detention,
and that is a major systemic problem," McLemore said. "Both the
federal and state prison system have enforceable detention standards,
but immigration has nothing like that."

The result, immigration advocates say, are deaths like that of a
Barbadian woman who died in 2005 while detained in Virginia after she
was denied her medication for high blood pressure.

That same year, Haitian writer Edwidge Danticat's uncle died in a
South Florida detention center after he was stopped at the Miami
International Airport, where his medications for hypertension and an
inflamed prostate were seized.

Immigration officials have denied any wrongdoing and said the deaths
were caused by pre-existing conditions.

Legal advocates, however, said medical problems at detention centers
are widespread.

"The No. 1 complaint I hear about is the lack of medical care for
immigrant detainees," said Tom Jawetz, a staff attorney with the
American Civil Liberties Union's national prison project in
Washington, D.C. "And typically the complaints come from detainees or
lawyers around the country."

In June, the ACLU's national prison project filed a federal lawsuit
over medical conditions at the San Diego Correction Facility, a
privately run detention center.

The lawsuit came after a detainee died and several others immigrants
suffered life-threatening illnesses.

Francisco Castaneda, a Salvadoran immigrant who was held at San Diego
and San Pedro, repeatedly asked to be taken to the infirmary when he
was at San Pedro last year, according to his lawyer, Conal Doyle.

Castaneda would show guards his bloodstained underwear, hoping to
persuade them to let him see a nurse or doctor, Doyle said.

In December, the ACLU's Jawetz sent immigration officials a letter
asking San Pedro officials to provide medical treatment, but nothing
happened.

Castaneda's health grew worse after a small lesion on his groin was
left untreated for 10 months while he was in detention, Doyle said.
Castaneda has since been released. His penis was amputated, and he is
now battling penile and lymph node cancer, Doyle said.

The ACLU's lawsuit comes too late for Arellano's family, who struggle
to understand an unexpected death and the federal government's actions
during those final days.

Sitting in her Ventura County apartment, Olga looks at the bags of
medication her son took and cries.

She said her greatest comfort has come from Arellano's fellow
detainees, who last week pooled their own money and sent the family
$245.

"I can only find the strength to talk about this because I want people
to know what is going on inside that place," Olga said. "I don't want
another family to have to live through this nightmare."

(c) 2007 Daily Journal Corporation. All rights reserved.