A transgender migrant from Honduras died in ICE custody last year from a rare, AIDS-related illness called multicentric Castleman disease, according to the official autopsy report released last week by the New Mexico Office of the Medical Investigator.
Activists had claimed in a wrongful death lawsuit that bruising and fractured ribs discovered by an independent medical examiner suggested that the migrant, Roxsana Hernandez, 33, had been abused while in detention.
But the state medical investigator said in a statement that it did not “share that conclusion,” noting that forceful CPR broke Hernandez’ ribs and caused the bruising.
The official autopsy concluded that Hernandez, who had been detained after requesting asylum, had “untreated HIV infection" and died from AIDS-related complications.
According to the autopsy and notes provided by Immigration and Customs Enforcement about Hernandez’ treatment while in custody, both it and Customs and Border Patrol were aware of Hernandez’ HIV status during her detention but still did not provide her with the necessary antiretroviral drugs.
“I think this person was denied the minimum standard required by U.S. law for prisoners and detainees,” Dr. Chris Beyrer, a public health professor at Johns Hopkins University, told NBC News after reviewing the official autopsy report.
Beyrer, who never examined Hernandez, said it is possible that Hernandez’ life could have been saved had she quickly been administered antiretrovirals. He added that those responsible for migrant detainees’ well-being “have an absolute moral, ethical and legal obligation to provide the minimum standard of care for detainees.”
He said this would “certainly include” antiretrovirals for HIV. “It was criminal to deny her” antiretrovirals, Beyrer said.
While an ICE spokesperson, Danielle Bennett, provided NBC News with a detailed timeline of Hernandez’ medical care while in ICE custody from May 13 until her death on May 25, Bennett was unable to say whether Hernandez was ever offered antiretrovirals, and if not, why not.
ICE also did not respond to Beyrer’s assertions.
According to ICE’s 2011 Performance-Based National Detention Standards, all detainees diagnosed with HIV/AIDS must be provided with medical care consistent with the recommendations and guidelines of the Department of Health and Human Services, the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Since 2012, the CDC has recommended that all HIV-positive people be immediately treated with antiretroviral drugs.
"We need internal processes to be established to ensure that detention centers comply not only with basic standards for providing people at least a dignified treatment, but also that they are not letting these immigrants die for need of some medication," said Fernando Garcia, founder and executive director of the Border Network for Human Rights, a nonprofit advocate for immigrants.
"The need for oversight is urgent," he said.
In a lengthy email sent to NBC News after this article's initial publication, an ICE spokesperson listed a number of ailments Hernandez had been diagnosed with when she was examined by medical professionals while in ICE custody, including septic shock, anemia and pulmonary disease. In a statement attributed to Capt. Philip Farabaugh, deputy medical director of ICE Health Service Corps, the message stated: "Generally hospitals do not initiate HIV therapy on a patient who has been diagnosed with significant medical issues, as in Hernandez’s case."
Perry Halkitis, an HIV/AIDS expert and the dean of Rutgers University School of Public Health, disputed ICE's claim: "The guidelines are very clear on HIV treatment — people should initiate, and be put on treatment, and sustained on treatment. There is no lack of clarity on that."