Time-sensitive healthcare guidelines for youth with chronic diseases in custody: gaps in care

On May 9th, 2023, a U.S. Border Patrol detained a family of five near Brownsville, TX. During processing, one of the family members, an eight-year-old girl, ADRA, was noted to have sickle cell anemia and a heart disease condition. Five days after they arrived at the Donna Facility, on May 14th, ADRA displayed symptoms, including abdominal pain and fever, and tested positive for Influenza A. She was administered medication and transferred to a designated isolation unit at the Harlingen Border Patrol Station. Despite her deteriorating condition and her mother's urgent requests for medical intervention, there were no documented consultations with an on-call physician or considerations for her transfer to a local hospital. On May 17th, ADRA's health critically declined, marked by multiple visits to the medical unit for vomiting and abdominal pain. An ambulance was dispatched only after ADRA experienced a seizure and became unresponsive, Fig. 1. Her subsequent death was deemed a "preventable tragedy" attributed to systemic failures in the Border Patrol's medical care and decision-making processes in a juvenile care monitor's report.¹ IMPACT: This article adds to the existing literature by: Summarizing the gap in age-specific guidelines for six chronic diseases that occur in children and adolescents held in custody. Identifying the lack of adequate intervention strategies for acute management of chronic diseases for youth held in custody and strategies for improving health equity.