Leaked recording: ICE Doctor in Charge of Family Detention Admits to Children Losing Weight

A partial transcript of a 20 minute recording of the meeting, in which health concerns at the now-closed Artesia detention center and the Karnes County Detention Center were discussed.

As originally published on Amoachi & Johnson

Dr. Jon Krohmer, MD the top doctor in charge of family detention.

Dr. Jon Krohmer, MD the top doctor in charge of family detention.

On September 24, 2014, a meeting  took place between several advocacy organizations, ICE Headquarters Officials, and the Chief Physician of ICE Health Service Corps, Dr. Jon Krohmer, MD.

Below is a partial transcript of a 20 minute recording of the meeting, in which health concerns at the now-closed Artesia detention center and the Karnes County Detention Center were discussed.

The highlights provided immediately before the full transcript show that the concerns raised recently–that family detention is has and always will be extraordinarily harmful to the physical and mental health of children as outlined in CARA’s complaint and our own..

More importantly, one can see that ICE officials have always been well aware that detention is harmful to children yet intentionally report to the public that is is safe, effective, humane, etc.

The individuals responsible for such grievous harm to children must be held accountable, starting the person who used his medical license to complete a conspiracy to commit crimes against children by detaining them with knowledge that it posed grave danger children, Dr. Jon Krohmer.

HIghlight 1: Lost Weight

“Dr. Krohmer, MD: Well i can tell you in the research that we have done and the (unclear audi)there have been some situations of weight loss of a couple of pounds. There have been no situations of weight loss reported by some of the media and organizations of 10 to 15 to 20 pounds. It just has not happened.”

What this means: A failed attempt to massage the facts.

When a child under 5 loses 2-3 pounds over the course of several weeks, it is a failure to thrive.

Children are supposed to grow, not shrink. For example, a 2 pound drop for from 20 to 18 pounds for a toddler would equate to him losing 10 percent of his body weight. ICE records for one of our clients show that the precipitating diagnosis that led to the decision to hospitalize him was “cough, congestion, fever and no weight gain for 21 consecutive days.”

The age of the client? 15 months old and he in fact lost weight, from an already diminished 21 pounds due to illness in border patrol custody and trip to the United States from the 25 pounds he was measured at in his home country down to a low of 19 pounds at the time he was rushed to the emergency room one hour away in Roswell, New Mexico.

Furthermore, if a child who weighs 20 pounds loses 10 pounds, the child would probably be dead.

When confronted with specific allegations without fear of public accountability, ICE leaders directly conceded what they have not admitted to date: at least several children jailed in Artesia and Karnes were losing so much weight proportionate to their body size that it posed a serious and imminent risk to their life.

Highlight # 2: Reckless malnutrtion of children 

Unidentified advocate: (Inaudible question regarding food)

ICE Headquarters Official: “We work very hard to make sure that there is food you know the proper food the reality is that the food is different, the food is going to be different from what they are used to growing up so there is going to be some challenges with diet…i think there was a request for rice and beans but also we’ve had some requests for instead of apples and fruits and milk in the refrigerator, other types of snacks that aren’t necessarily healthy, so

(Laughter by several individuals in room after joke on snacks is made)

ICE official: “So I mean you all, like I have kids, we all have kids at home, so they are not going to reach for the apple, but the goldfish or the chips and candy so we are working through those challenges uh at the same time they have free access to fruit, and milk and juice and water. the refrigerators are open 24/7. They have free access in their dorms.”

What this means: a top ICE official acknowledged advocates reports that many children were not eating the food ICE provided in Karnes and Artesia because, allegedly, “the food is…different” from what they were accustomed to at home.”

The solution proffered to knowing that many children, some under 2 years old or even under 12 months, were not eating was to work “through those challenges and have free access to fruit, milk and juice, and water.”

The only reason these children had ceased to eat, according to ICE, was that the food was too unfamiliar. The only way to “work through a challenge” to ensure a child who is not eating starts eating is to eliminate the root cause: their detention so that the mother has the liberty to make sure her child does not become permanently injured due to malnutrition or suffer pangs of hunger from not eating or barely eating anything over spans of days, weeks, or months.

Highlight # 3: Policy To Detain Children Who Are Seriously Ill

Bryan Johnson: “If i could chime in, my name is Bryan Johnson I am an attorney in New York. I had a client, a 1 year old, that was detained at artesia for 72 days. He had a fever for 17 straight days that resulted in pneumonia and he was treated at the hospital and right after being released from the hospital he was sent right back to the detention facility in Artesia where he subsequently contracted a fever for another 13 days straight and he was very ill for the whole time so I was wondering if there was anything to address the concerns about the extremely ill children?ICE Headquarters Official: “Is there any question regarding medical care, because I do have Dr Krohmer here…”

(no response)

Krohmer: “I mean we’ve got the health folks going throughout the camp, you know, almost 24 hours a day they walk through at night…and uhh sick call rooms and clinic rooms and in dormitories…we have 3 pill lines in each of the dormitories there are more than adequate opportunities for folks expressing health concerns to be investigated.

Admittedly, you are hearing concerns expressed by the moms. We need to try to validate them. It is not the experience that our healthcare providers have seen.”

Bryan Johnson: “I can, I spoke before , Bryan Johnson, I can validate the concerns because i have the medical records of my client, um, and I have another client that is there and I know you didn’t address the fever issue yet, but in most states the law states that for a child day care center if there is a child that is sick, with a fever over 101, they have to be sent home, and I don’t think that’s happening at Artesia or Karnes, and that’s why i think it’s happening, it happened to my client, and i want to make sure it’s not happening to other children, because it was really scary for me as their attorney to hear my client had a 104 fever and was being sent to the hospital and he wasn’t even released after that.

Dr. Jon Krohmer: “Ok, well, he was appropriately cared for at the hospital I can assure you.”

(no further response until several minutes later)

Dr. Jon Krohmer: And I understand that, we have heard that on the rotations, and I guess, to be frank, I’m going to be politically inappropriate, I mean it does not surprise me at all that the information and the claims and information that some of the attorneys are getting are in fact what the clients are suggesting to them. When those situations occur, when there are concerns about healthcare, we need to have it brought to our attention. To be looked into. to be…and whether it is due to a lack of understanding…or a lack of…I mean I can tell you our health care providers are being told, and this is the politically inappropriate part of it, our health care providers are being told by some of the residents that they want to be returned home to be back with their families but their attorneys are telling them they can’t leave yet. So I say that only to suggest that it appears no matter what side of the fence you are on the information and the perspective that you, i mean i’ve got to be honest, your comment that getting folks with medical issues under detention is very difficult is wrong…(interrupted)

Bryan Johnson: With all due respect doctor, my client, I do have corroboration, and I I, was hearing things from my client that matched up exactly with what the report said and I don’t think you had answered it prior to, I am wondering why, since he was diagnosed with pneumonia what the procedure was, why the child was returned to the facility, um, I mean it seems to me that in my experience it did match up exactly with what the records said, so are there incidents where there are children that are seriously sick and what is the process to get them out?

Dr. Jon Krohmer: “Well, the the your particular client did get sicker um he didn’t respond to the antibiotics he was given in the facility because his infection was caused by a virus not a bacteria which can be treated with an antibiotic…”(Interrupted)

ICE Headquarters Official: “we probably, well…”

(Unidentified advocate also agreeing not to talk about individual case)

Bryan Johnson: “I mean i do not need to know the specifics of my client, I just as a general question, is there a procedure for children that get ill, what’s the procedure to release them?”

ICE Headquarters Official: “I don’t think there is a procedure per se but what we look at every case and if a decision or recommendation from the doctor that this particular adult or child would be better suited outside of the facility or elsewhere, that recommendation is made and normally decided immediately, but the reality is, like your example about daycare, I have kids that go to daycare, you are right, kids stay at home if they have a fever but this is not day care per se, so the medical decision is made by the doctors and uh we will never contradict the doctors and say, no, sorry, we are going to detain the person when the medical decision is to release”

Dr. Jon Krohmer: “The fact that somebody has a fever doesn’t qualify.”

Bryan Johnson: But not just the ICE doctors, what if they are in the hospital, what if the hospital doctor has one instruction and then the ICE doctor reverses it, because that is what happened in this case. The, I mean i don’t want to talk about my specific client but it’s just an example of the doctor at the hospital said stay away from other children that are sick and what actually happened was he was put in a place with other children that are sick so the decision was made against the doctors orders.

ICE Headquarters Official: “uh uh ok, well, Like you said I can’t speak to that but uh, we do, uh, the medical care is at the top of our list…”

Bryan: “Right.”

Unidentified Advocate: “I’m going to have to move us through this but maybe we could address in a follow up in a separate conversation, not only about the specifics of any case but on you know procedural issues that i think he is trying to raise here.”

What this means: Family detention was designed to detain children no matter what, even if a child became acutely ill and required emergency hospitalization. The health of children in U.S. detention facilities was entirely disregarded so that individual goals of President Obama could be carried out: to stop the appearance of a porous border by detaining children with no regard whatsoever to that child’s life.

Starting with Dr. Jon Krohmer, physicians who signed for children to be “medically cleared for custody” violated their duty to act in the best health interests of their patients.

This recording shows that several individuals acted in an agreement to continue to detain a child knowing it was harming them or posed an imminent risk of harm to their physical and mental health. The backdrop of this case also makes it highly likely that DHS Secretary Jeh Johnson and President Barack Obama were directly implicated in this particular case, as it was covered by a major New York Times article by Julia Preston on August 5, 2014.

My client’s case is not the exception, shockingly. In Artesia, Berks, Karnes, and Dilley, children face life-threatening health emergencies and serious physical or mental health problems on a routine basis.

When will the individuals responsible for harming children be held accountable for their actions?

How can we stop this abhorrent serial criminal child abuse from continuing or returning in the future?

By holding the individuals responsible for the harm accountable. By creating a real price for them to pay for their wrongful conduct. Without that price, the current officials and future ones will be de facto given a license to violate the law for at least the several months or years it takes for a federal judge to be in a position to hold them in contempt of court.

Impunity for the harms inflicted on children in family detention is the main obstacle that has prevented achieving its permanent extinction.

ICE or CCA did not harm the children. Individuals with final authority or who were necessary for that authority to be exeercised over the children’s’ custody harmed the children.  Dr. Jon Krohmer harmed my client by signing repeatedly signing off on his detention, as he has done to every child who passed through the family detention camps.

Here are the top officials who must be held accountable for creating, planning, and executing the conspiracy of serial child abuse and neglect through the creation of family detention starting in June of 2014:

President Barack Obama

DHS Secretary Jeh Johnson

ICE Director Sarah Saldana

ICE ERO Director Thomas Homan in addition to other ICE HQ officials with authority over custody determinations.

Field Office Director Enrique Lucero

Field Office Director Adrian Macias

Dr. Jon Krohmer (and all medical professionals that authorized detention of children)

The audio may be available by individual request. Bryan@amjolaw.com

————————————————————-start of transcript—————————————————————-

ICE Headquarters Official: “Is there any question regarding medical care, because I do have Dr Krohmer here…”

Unidentified advocate: “I would certainly flag, and invite others to chime in, something that we observed both in our karnes and artesia tours, were mothers are universally saying that their children were losing weight, that they were not eating, and even if they were eating they were having diarrhea. I was told at Karnes that they swipe cards for them to get into the cafeteria so they can track who has meals, but the fact that they enter room does not show if they are eating it or how their gastrointestinal system is handling it. So, um, at karnes we tried to make the suggestion that children who are weighed at intake be proactively weighed again to identify trends of weight loss because what we were told by the medical staff during our q and a session they would certainly look into any concerns that were raised if a mother made an appointment for their child. We were trying to flag that it was being universally expressed to us that you shouldn’t have to wait for that appointment so i think that that was one of our top concerns from our tours is that we would love to see some proactive engagement on the weight loss issue to the extent that it can be addressed for family detention, which is, as we’ve said, (unclear)

Bryan Johnson: “If i could chime in, my name is Bryan Johnson I am an attorney in New York. I had a client, a 1 year old, that was detained at artesia for 72 days. He had a fever for 17 straight days that resulted in pneumonia and he was treated at the hospital and right after being released from the hospital he was sent right back to the detention facility in Artesia where he subsequently contracted a fever for another 13 days straight and he was very ill for the whole time so I was wondering if there was anything to address the concerns about the extremely ill children?

Dr. Jon Krohmer.  “Well I’ll do the weight loss thing first. Um, actually at Artesia and Karnes both we are recording weights anytime there is a clinic engagement between a resident and a medical staff and that includes both physical health issues and mental health issues…Every time they engage in physical or mental health encounter they are being weighed.

Unidentified advocate: “I guess I would just reiterate request if possible during some headcount that everybody gets weighed, or some other opportunity where it’s done more proactively, hopefully…come to learn that it’s not a problem or if it is a problem we can address it systemically.”

Dr. Krohmer, MD: Well i can tell you in the research that we have done and the (unclear audi) there have been some situations of weight loss of a couple of pounds. There have been no situations of weight loss reported by some of the media and organizations of 10 to 15 to 20 pounds. It just has not happened.

Advocate, unidentified: “We can only report our encounters”…Dr. Krohmer interrupts.”

Krohmer,“I understand”

Unidentified advocate: (interrupted arguing) without objective data it’s hard…

DHS has consistently insisted thatDr. Krohmer: I am providing you with…

Unidentified ICE official: In…specific cases, if there is a child you feel like needs to be weighed or has health concerns, i mean, that’s the last thing we really want, somebody with health concerns in our custody…

Krohmer: “I mean we’ve got the health folks going throughout the camp, you know, almost 24 hours a day they walk through at night…and uhh sick call rooms and clinic rooms and in dormitories…we have 3 pill lines in each of the dormitories there are more than adequate opportunities for folks expressing health concerns to be investigated.

Admittedly, you are hearing concerns expressed by the moms. We need to try to validate them. It is not the experience that our healthcare providers have seen.”

Bryan Johnson: “I can, I spoke before , Bryan Johnson, I can validate the concerns because i have the medical records of my client, um, and I have another client that is there and I know you didn’t address the fever issue yet, but in most states the law states that for a child day care center if there is a child that is sick, with a fever over 101, they have to be sent home, and I don’t think that’s happening at Artesia or Karnes, and that’s why i think it’s happening, it happened to my client, and i want to make sure it’s not happening to other children, because it was really scary for me as their attorney to hear my client had a 104 fever and was being sent to the hospital and he wasn’t even released after that.

Dr. Jon Krohmer: “Ok, well, he was appropriately cared for at the hospital I can assure you.”

Unidentified advocate: (unclear question regarding how clinical interaction at facilities take place.)

Dr. Jon Krohmer: “It’s the same when you take your 2 year old to the doctor’s office. They take blood pressure…oxygen saturation, temperature, and the weight.

It’s no different than when your daughter is taken care of, you know, your doctor will say if she is not better in 2 days come back and see me. if they are better don’t worry about it.”

Unidentified advocate: (inaudible question)

ICE Headquarters Official: “It’s something we can look at. I mean, what i think you are asking is that we walk around every couple of days and weigh the kids and I don’t know necessarily if that is the best use of medical resources, but at the same time if there are challenges we want to know about them, but the medical care that is being provided is, I think you would agree, is good medical care. Some of these families have never seen a doctor before in their life, umm.”

Dr. Jon Krohmer: “And I would offer, that last factor aside, we have staff that is available 24 hours a day 7 days a week, sick calls.”

ICE Headquarters Official: “there’s no restrictions for them for requesting to see a doctor at family detention.”

Unidentified Advocate: “…At that initial wellness check, that baseline weight…”

(inaudible exchange)

So is there a baseline and you are saying that every encounter includes a weight check so there should be a record of weight…”

Unidentified advocate: (Inaudible question regarding food)

ICE Headquarters Official: “We work very hard to make sure that there is food you know the proper food the reality is that the food is different, the food is going to be different from what they are used to growing up so there is going to be some challenges with diet…i think there was a request for rice and beans but also we’ve had some requests for instead of apples and fruits and milk in the refrigerator, other types of snacks that aren’t necessarily healthy, so

(Laughter by several individuals in room after joke on snacks is made)

ICE official: “So I mean you all, like I have kids, we all have kids at home, so they are not going to reach for the apple, but the goldfish or the chips and candy so we are working through those challenges uh at the same time they have free access to fruit, and milk and juice and water. the refrigerators are open 24/7. They have free access in their dorms.”

Second  ICE Headquarters Official: “We heard this from advocacy community in artesia, and the way we message it back, again we have done family detention on a smaller scale at berks however these wellness checks are trained professionals persons, right? so when they see problems (with weight) that are clear they are going to be proactive engaged to say what’s going on, secondarily, we want to ensure that the wellness check that builds rapport so the mother feels comfortable so that after the time of the standardized wellness check the mother…I’m the parent, I know that my child has an issue that is flagged at wellness check. Two points where we can see observable demarcations at various weights,and the ability to build rapport first and foremost with the medical health providers which Dr. Krohmer spoke…so although we can talk about logistics, scale etc. it does not mitigate the fact that we have trained medical health professionals, public health service, doing positive, doing good healthcare the world over…”

Unidentified Advocate:” I want to raise one more point that i have heard from aila attorneys.”

The concern I wanted to raise, um, was that at least one attorney was told by her client that no medicine was given unless the fever was over 104.”

Dr. Jon Krohmer: “That is blatantly inaccurate.”

Unidentified Advocate: “And it may be but it may also be lost in translation or there may be problem with the rapport between the medical provider and the resident um i use that as an example of the perception at least of…available and we’ve also heard concerns regarding diarrhea where the resident have been under impression only that pain relief medication is available, so something is going on that rapport is not as seamless as it needs to be, and the mothers feel like medicine is not available.”

Dr. Jon Krohmer: And I understand that, we have heard that on the rotations, and I guess, to be frank, I’m going to be politically inappropriate, I mean it does not surprise me at all that the information and the claims and information that some of the attorneys are getting are in fact what the clients are suggesting to them. When those situations occur, when there are concerns about healthcare, we need to have it brought to our attention. To be looked into. to be…and whether it is due to a lack of understanding…or a lack of…I mean I can tell you our health care providers are being told, and this is the politically inappropriate part of it, our health care providers are being told by some of the residents that they want to be returned home to be back with their families but their attorneys are telling them they can’t leave yet. So I say that only to suggest that it appears no matter what side of the fence you are on the information and the perspective that you, i mean i’ve got to be honest, your comment that getting folks with medical issues under detention is very difficult iswrong…(interrupted)

Bryan Johnson: With all due respect doctor, my client, I do have corroboration, and I I, was hearing things from my client that matched up exactly with what the report said and I don’t think you had answered it prior to, I am wondering why, since he was diagnosed with pneumonia what the procedure was, why the child was returned to the facility, um, I mean it seems to me that in my experience it did match up exactly with what the records said, so are there incidents where there are children that are seriously sick and what is the process to get them out?

Dr. Jon Krohmer: “Well, the the your particular client did get sicker um he didn’t respond to the antibiotics he was given in the facility because his infection was caused by a virus not a bacteria which can be treated with an antibiotic…”(Interrupted)

ICE Headquarters Official: “we probably, well…”

(Unidentified advocate also agreeing not to talk about individual case)

Bryan Johnson: “I mean i do not need to know the specifics of my client, I just as a general question, is there a procedure for children that get ill, what’s the procedure to release them?”

ICE Headquarters Official: “I don’t think there is a procedure per se but what we look at every case and if a decision or recommendation from the doctor that this particular adult or child would be better suited outside of the facility or elsewhere, that recommendation is made and normally decided immediately, but the reality is, like your example about daycare, I have kids that go to daycare, you are right, kids stay at home if they have a fever but this is not day care per se, so the medical decision is made by the doctors and uh we will never contradict the doctors and say, no, sorry, we are going to detain the person when the medical decision is to release”

Dr. Jon Krohmer: “The fact that somebody has a fever doesn’t qualify.”

Bryan Johnson: But not just the ICE doctors, what if they are in the hospital, what if the hospital doctor has one instruction and then the ICE doctor reverses it, because that is what happened in this case. The, I mean i don’t want to talk about my specific client but it’s just an example of the doctor at the hospital said stay away from other children that are sick and what actually happened was he was put in a place with other children that are sick so the decision was made against the doctors orders.

ICE Headquarters Official: “uh uh ok, well, Like you said I can’t speak to that but uh, we do, uh, the medical care is at the top of our list…”

Bryan: “Right.”

Unidentified Advocate: “I’m going to have to move us through this but maybe we could address in a follow up in a separate conversation, not only about the specifics of any case but on you know procedural issues that i think he is trying to raise here.

———————————————End of Transcript Excerpt———————————————–

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