Does Your Medical Center Have a Contract With ICE? These Do.

As controversy swirls around physician involvement with migrant detention centers, a Medscape analysis has found that four major medical centers have contracts with US Customs and Border Protection (CBP) or Immigration and Customs Enforcement (ICE) to provide services they say will improve conditions for migrants at the US-Mexico border, including developing medical and triage protocols for adults and children.

Medscape Medical News' analysis found that Brigham and Women's Hospital, Columbia University, Johns Hopkins University, and Texas Tech University Health Sciences Center have or have had contracts ranging from just under $10,000 up to $2 million for medical services. For both medical and nonmedical services, a dozen institutions were found to have 17 contracts total, and some institutions have multiple contracts.

Medical centers have had contracts with CBP and ICE in the past, but of the currently running contracts, all but one of the 17 began in 2017, after the Trump administration took a more hardline approach to immigration.

At least one institution, Harvard Medical School-affiliated Brigham and Women's Hospital, has said it is canceling its contract with CBP to provide "guidance for medical triage protocols at the southern border," Medscape Medical News has learned.

The institutions have contracted to provide a variety of services, including tactical medical training, university-level education and training services, strategic planning facilitation services, and medical direction services.

Hospital administrators and many physicians say they have a moral obligation to do what they can to help ease the suffering at the southern US border, but other physicians and healthcare workers contend it is wrong to support a system they believe abuses detainees attempting to seek asylum in the United States.

In a commentary published online August 30 in JAMA, Paul Spiegel, MD, MPH, and colleagues from Johns Hopkins University provide recommendations for how clinicians should work with migrants at the border. "Whatever the future of US immigration policy, decent and humane treatment of children, as well as all other detainees, and preservation of the independence of physicians and other health professionals to meet patients' medical and psychological needs are essential," they write. "Now is not a time to change the commitments, reputation, and integrity of physicians and the medical profession."

In response, an ICE spokesperson told Medscape Medical News in an emailed statement that the agency has "several levels of oversight in order to ensure that residents in ICE custody reside in safe, secure and humane environments."

Those levels of oversight include receiving "a comprehensive physical exam within 14 days of arrival to identify medical, mental health and dental conditions that require monitoring or treatment." In addition, all detainees should expect "timely and appropriate responses to emergent medical requests, and timely medical care appropriate to the anticipated length of detention. At no time during detention will a detainee be denied emergent care," the statement continues.

CBP did not respond to multiple requests for comment.

Major Medical Center Involvement

The four major medical centers, plus Marshall University through its research corporation, have or have had a total of eight contracts with CBP or ICE that expired this year or later. Johns Hopkins has four of those contracts, all with ICE. Two of the four expired earlier this year. The remaining two are for "tactical medical training" ($941,780) and "universitylevel education and training services" ($348,768).

Table 1. Institutions With ICE/CBP Medical Care Contracts

Institution	Agency	Purpose	Contract Fee	Start Date	End Date	Status
Brigham and Women's Hospital	CBP	"guidance for medical triage protocols at the southern border"	$150,000	June 17, 2019	June 16, 2020	Canceled
Columbia University	CBP	guidance "for medical triage protocols at the southern border"	$150,000	May 29, 2019	May 31, 2020	Current
Johns Hopkins University	ICE	"tactical medical training"	$941,780	September 20, 2015	September 19, 2019	Current
Johns Hopkins University	ICE	"university level education and training services"	$348,768	April 20, 2019	September 29, 2019	Current
Johns Hopkins University	ICE	"strategic planning session to improve vission [sic]/goals"	$28,830	September 13, 2018	February 16, 2019	Expired
Johns Hopkins University	ICE	"strategic planning facilitation services"	$9011	March 25, 2019	May 31, 2019	Expired
Marshall University Research Corporation	ICE	"opioid crisis support services"	$1,750,000	August 26, 2019	August 25, 2020	Current
Texas Tech University Health Sciences Center	CBP	"medical direction services"	$176,604	July 1, 2017	June 30, 2020	Current

Brigham and Women's Cancels $150,000 Contract With CBP

Harvard Medical School-affiliated Brigham and Women's Hospital in Boston, Massachusetts, entered into a $150,000 contract with CBP in June, as reported by the Harvard Crimson. The hospital agreed to provide a subject-matter expert who could offer guidance on "medical triage protocols at the southern border." The contract began on June 17, 2019, and ends on June 16, 2020, according to information on USASpending.gov.

A hospital spokesperson said that contract is being canceled.

The subject-matter expert, Michael VanRooyen, MD, MPH, "an emergency physician and humanitarian expert, had a consulting contract to advise the [CBP] regarding necessary medical services for children arriving at the border. Dr VanRooyen's expertise has not been sought as a result of this contract, there have been no financial transactions, and the contract is in the process of being canceled. We are not aware of any other contract with CBP or ICE," a hospital spokesperson told Medscape Medical News.

When asked for a reason for the cancellation, the spokesperson said that VanRooyen's contact had left CBP, which made him want to cancel the contract.

The contract was still listed as ending on June 16, 2020, on USAspending.gov as of September 11, 2019.

Columbia University Gets $150,000 Contract

Columbia University in New York City also has a contract to provide "[SME guidance] for medical triage protocols at the southern border" for $150,000 with CBP. The contract began on May 29, 2019, and ends on May 31, 2020, according to USAspending.gov.

Asked for comment, a spokesperson for Columbia University sent a statement attributed to Irwin Redlener, MD, director, National Center for Disaster Preparedness; professor of health policy and management and pediatrics at the Mailman School of Public Health at Columbia University; and president emeritus of Children's Health Fund.

"The idea of directly working with [CBP] and US Border Patrol is clearly a challenge on many levels. However, having seen first-hand the horrendous conditions that are creating a very high risk situation for children in custody, the idea of not helping if given the opportunity to do so would be ethically and morally counter to everything I have been doing as a pediatrician for nearly fifty years," Redlener said in the statement.

The university did not reply to a question about whether Columbia University plans to renew that contract.

In early July, more than 300 faculty, students, and alumni signed a petition, saying the contract "is a stain on our conscience and reputation as an institution that upholds human rights and ethical practices" and demanding that the university cancel the contract, as reported by the Columbia Spectator and the Washington Times .

Nara B. Milanich, PhD, a professor of history at Barnard College, helped draft the petition. She told Medscape Medical News that she believes medical care is needed at the southern US border and that "reasonable people can disagree" about whether it is best to provide that care within the current system or outside of it.

Milanich said she "would not presume to tell a doctor how exactly they should engage and that they should engage like I do" and that she believes those who made this contract "have absolutely the best intentions in the world."

But Milanich said there is an inherent conflict in physicians working for CBP; she believes having independent medical monitors in CBP facilities is the best approach.

Johns Hopkins University Has Had Multiple ICE Contracts

Johns Hopkins University in Baltimore, Maryland, has a contract for $941,780 with ICE to provide "tactical medical training," according to USAspending.gov. That contract began on September 20, 2015, and ends on September 19, 2019.

ICE also awarded Johns Hopkins University a contract for $377,046 for "university level education and training services," according to USAspending.gov. That contract began on April 10, 2019, and ends on September 29, 2019.

In addition, Johns Hopkins University entered into a $9011 contract with ICE for "strategic planning facilitation services," according to USAspending.gov. That contract began on March 25, 2019, and ended on May 31, 2019.

Johns Hopkins also had a fourth contract, which ended in February 2019. Originally for the amount of $36,860, ICE ended up paying $28,830 for a "strategic planning session to improve vission [sic]/goals," according to USAspending.gov.

"The Johns Hopkins University School of Medicine has had a contract with [ICE] since 2004. Our Center for Law Enforcement Medicine has several contracts with federal agencies, including the US Secret Service (since 1999), the Bureau of Alcohol, Tobacco, Firearms and Explosives (since 2007) and the US Marshals Service (since 2007)," a Johns Hopkins Medicine spokesperson said in a statement to Medscape Medical News.

"Through these contracts, our medical experts provide specialized emergency medical response training and medical direction to federal law enforcement personnel who are cross-trained as paramedics and emergency medical technicians. The medical training that the Johns Hopkins Center for Law Enforcement Medicine provides has no relationship to the enforcement of immigration policies by the current or any other administration, nor does it constitute an endorsement of any administration's immigration policies," according to the statement.

Johns Hopkins has also had a contract with CBP that was for more than $65 million over a 5-year period, according to USAspending.gov. It doesn't seem to have a direct connection with medicine — the contract was with the university's applied physics lab — but the university did not respond to multiple queries about its purpose. The contract expired on August 31, 2019.

Hopkins Clinicians Respond

Clinicians and others in a group called the Hopkins Coalition Against ICE sent a letter to the Johns Hopkins University Center for Law Enforcement Medicine in July, requesting detailed information about its contract, including what services it is providing, whether those services include direct care of refugees or migrants, and what recommendations it has provided to ICE, within 14 days. As of late August, the coalition had not received a response, bioethicist Zackary Berger, MD, PhD, told Medscape Medical News.

Berger is an associate professor at the Johns Hopkins School of Medicine, core faculty at Johns Hopkins Berman Institute of Bioethics, and a staff physician at Esperanza Center Health Services Clinic, all in Baltimore, Maryland. This issue is important to him because some of his patients are immigrants, he said.

"I think the number of sympathetic voices is quite significant because there was a petition against ICE circulated by an Arts and Sciences faculty member, Drew Daniel, this past year," Berger said. That petition was signed by almost 2000 individuals, most of them students, faculty, staff, and alumni at Johns Hopkins.

An editorial published in July in the Washington Post also takes issue with the ethics of working for ICE and others involved with detaining migrants.

"Acting in the patient's best interest is the most fundamental tenet of medical ethics, professional duty and moral practice, so a job that requires the physician put the philosophy of the facility first — an immigration detention center run by a for-profit private company under harsh and inhumane orders from the government — runs counter to everything we doctors are told is our highest duty," wrote Ranit Mishori, MD, MHS, from MedStar Georgetown University Hospital in Washington, DC, and Physicians for Human Rights. (Mishori is a contributor to Medscape Family Medicine).

Texas Tech University Contract

Beginning on July 1, 2017, CBP awarded Texas Tech University Health Sciences Center (TTUHSC) in El Paso a $176,604 contract to provide "medical direction services," according to USAspending.gov. The contract ends on June 30, 2020.

A TTUHSC El Paso spokesperson told Medscape Medical News the university's Department of Emergency Medicine provides medical direction to CBP emergency medical technicians in the area, suggests medical protocols they can adopt, and consults on other issues, including making equipment recommendations.

"The contract also includes continuous medical education at the prehospital provider level, which allows for the officers operating as emergency medical responders to maintain their medical knowledge, skills, and licensure," the spokesperson explained.

CBP is required to offer the contract out for bids when it is up for renewal in 2020 and the university has been awarded the contract thus far, she said, adding TTUHSC El Paso has no other contracts with CBP or ICE.

Contracts for Nonmedical Services

Several universities and one state college also have entered into contracts with CBP and ICE for nonmedical services, according to information on USAspending.gov. The services include counterterrorism training, leadership training, firearms range usage in support of CBP, and curatorial services.

This list may not be all-inclusive, and it is unclear whether any of these contracts will be renewed.

Table 2. Institutions With ICE/CBP Nonmedical Care Contracts

Institution	Agency	Purpose	Contract Fee	Start Date	End Date
Florida State College at Jacksonville	CBP	"Firearms range usage in support of CBP"	$10,363	April 1, 2017	September 30, 2019
Robert H. Smith School of Business Foundation, University System of Maryland	CBP	Education/training- training/curriculum development	$362,500	May 16, 2019	February 14, 2020
Robert H. Smith School of Business Foundation, University System of Maryland	CBP	Education/training- training/curriculum development	$362,500	May 16, 2019	March 6, 2020
Syracuse University, New York	CBP	"Curatorial services"	$4,625	September 30, 2017	September 19, 2020
University of Maryland, College Park	ICE	"Counterterrorism training"	$225,000	July 21, 2017	January 5, 2022
University of Southern California	CBP	Strategic resources assessment for the land ports of entry	$2 million	September 14, 2019	September 14, 2020
University of Washington, Seattle	CBP	CANUS Pilot Phase II	$125,000	April 30, 2019	October 31, 2019
Utah State University Research Foundation	CBP	Engineering/technical: Contract for R&D for the TARS modernization	$4.1 million	September 26, 2018	September 25, 2020

Whether the medical care contracts are renewed may depend on continued protests by those who disagree with ICE and CBP policies.

Milanich, the professor who co-launched a petition against these contracts, noted that despite good intentions on the part of clinicians, "You can't enact those good intentions when you are on the payroll of the people who are causing the harm."

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Medscape Medical News © 2019 

Cite this: Troy Brown. Does Your Medical Center Have a Contract With ICE? These Do. - Medscape - Sep 12, 2019.