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HHS’s zero tolerance for children (er, something like that)

March 6, 2020

Topics: Quote of the Day

U.S. Department of Health and Human Services, Office of Inspector General, March 2020

Why we did this study

In spring 2018, the Department of Justice and Department of Homeland Security (DHS) adopted a zero-tolerance policy under which large numbers of families entering the United States without authorization were separated by DHS. Typically, adults were held in Federal detention while their children were placed in Department of Health and Human Services (HHS) custody and provided care through the Unaccompanied Alien Children (UAC) Program. A Federal district court subsequently ordered the Federal Government to reunify separated families who met certain criteria. Given the impact of the zero-tolerance policy on vulnerable children and families, OIG conducted this review to examine challenges that HHS faced in responding to the zero-tolerance policy and carrying out the reunification effort.

How we did this study

This report synthesizes information from interviews with, and written responses from, senior HHS officials and HHS staff; interviews with staff at 45 HHS-funded care provider facilities under the UAC Program; case reviews for a purposive sample of separated children; and more than 5,000 documents obtained through requests to the Department, from facility staff, and from interview respondents. We analyzed interview and documentary data to identify significant challenges that HHS and facilities faced in responding to the zero-tolerance policy and reunifying separated children, as well as factors that contributed to those challenges.

What we found

Interagency channels for coordinating immigration policy across Federal departments were not used to notify HHS of the zero-tolerance policy in advance. Meanwhile, key senior HHS officials did not act on staff’s repeated warnings that family separations were occurring and might increase. HHS’s lack of planning for the possibility of larger-scale family separation left the Department unable to provide prompt and appropriate care for separated children when the zero-tolerance policy was implemented. Further, because no procedures or systems had been established to track separated families across HHS and DHS for later reunification, HHS struggled to identify separated children. Additionally, care provider facilities faced significant operational challenges at every stage of the reunification process, complicated by poorly-communicated guidance from HHS. Finally, HHS has taken steps to improve tracking of separated children, but the procedures include manual processes that are vulnerable to error.

What we recommend

HHS should take steps to ensure that children’s interests are prioritized and represented in decisions affecting the UAC Program, both internally and when engaging with interagency partners. HHS should also modify or pursue formal agreements with DHS and DOJ to ensure that it is receiving information that supports its operation of and ability to provide care for children in the UAC Program. Additionally, HHS should improve communication to care provider facilities regarding interim guidance, operational directives, and other instructions that are not immediately available in published policy documents. Finally, HHS should further improve its ability to identify and track separated children by reducing reliance on manual processes.


Complete report (70 pages):

HHS was unprepared for Trump family separation policy, watchdog says

By Nathaniel Weixel
The Hill, March 5, 2020

Poor communication and internal management decisions left the Department of Health and Human Services (HHS) ill-prepared to respond to the Trump administration’s “zero tolerance” policy of family separations, according to an internal watchdog report released Thursday.

The report from HHS’s Office of Inspector General paints a picture of an agency caught off guard and struggling to catch up with its response. The lack of preparation hurt the agency’s ability to identify, care for and ultimately reunite children who had been separated from their parents.

According to the inspector general, senior HHS officials had no idea the family separation policy was being implemented by the departments of Justice and Homeland Security until they learned about it from media reports.

The lack of planning for large-scale separations also resulted in the agency being unable to provide “prompt and appropriate care” for separated children.

It created a lack of available bed space, leaving hundreds of children inappropriately detained in Department of Homeland Security (DHS) custody, instead of with HHS.

And at the same time, the report found that warnings from staff were ignored. Key senior officials with HHS’s Administration for Children and Families (ACF) “did not act on staff’s repeated warnings that family separations were occurring and might increase,” the report said.

According to the report, “no procedures or systems had been established to track separated families across HHS and DHS for later reunification.”

The official policy resulted in about 2,700 children being separated from their parents over a six-week period in the spring of 2018.

Last fall, the ACLU said that an additional 1,500 children were separated than previously disclosed, bringing the tally to more than 4,000 from the roughly 2,700 children previously known to have been separated that year.



By Don McCanne, M.D.

No, this report is not about single payer Medicare for All, but rather it is about a program initiated by a government that the people elected to implement important public programs.

In this instance, after Donald Trump was elected president, he instituted aggressive immigration policies that included forcibly separating immigrant children from their parents. Without adequate preparation or management, the children were transferred from the Department of Homeland Security to the Department of Health and Human Services – an agency that should certainly be sensitive to the physical and emotional needs of children. The report does indicate that they were successful in inducing protracted periods of crying amongst the children – therapeutic emotional venting, I suppose.

We have observed this administration’s management of other government health programs, including its attack on the provisions of the Affordable Care Act. Can you imagine what their approach might be if we already had a single payer model of Medicare for All up and running? Elections do matter.

As a democracy, we can change the political culture by becoming well informed on the policies supported by the various political candidates, and then by carefully casting our votes appropriately. But instead of selecting a candidate who is empirically perceived as having the best chance of displacing a bogeyman, we should choose a candidate based on support of public policies that would serve America best.

In the meantime, to help bring an end to our nation’s cruel immigration policies, we should consider placing Stephen Miller in a cage for the duration of Trump’s term, maybe along with the humane gesture of supplying him with a crying towel.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

About the Commentator, Don McCanne

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Don McCanne is a retired family practitioner who dedicated the 2nd phase of his career to speaking and writing extensively on single payer and related issues. He served as Physicians for a National Health Program president in 2002 and 2003, then as Senior Health Policy Fellow. For two decades, Don wrote "Quote of the Day", a daily health policy update which inspired HJM.

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