In recent weeks, even as the federal government shed workers, news reports emerged of hiring at detention facilities run by the U.S. Department of Homeland Security. According to Politico, the Trump administration sought to hire health care providers for immigration detention centers around the country “as deaths in custody mount and federal oversight is weakened by layoffs.”

But the issue of staffing shortages and health care access is not new in detention centers. LDI Fellow Joseph Nwadiuko recently published a snapshot of the situation. The study, in The Journal of General Internal Medicine, examined health care staffing data from 21 facilities, representing 15% of facilities and 35% of the average daily population of detainees between 2019 and 2022 and all of the facilities where the government directly manages healthcare instead of contracting it out.

The findings are dramatic: More than half of the facilities lacked continuous physician coverage for at least one year.  About half of the facilities had no continuously employed psychiatry providers for at least one year. Five facilities had no behavioral health providers of any type, and six reported attempted suicides in the same year.

More than 10% of the physicians working at the facilities had state sanctions against them for issues such as poor or fabricated medical documentation or practicing under the influence.

What led you to study staffing and the quality of care at immigration detention centers?

Nwadiuko: There have been years of complaints of poor care in immigration detention but we have been unable to get good data on health staffing mixes that could be paired with health care delivery.

But some research in this area was based on serendipity. The reports supplying the underlying data for staffing levels were found through unrelated internet searches;  ICE does not have any clear landing pages for them. ICE responded to a Freedom of Information Act request seeking staffing tabulations with identifying information for providers, which allowed us to look up credentialing information.

What is your most important finding about care at immigration detention facilities?

Nwadiuko: Many of the facilities where the government provides care struggle with physician and mental health staffing, with multiple facilities reporting at least partial-year vacancies. Most worrisome, staff-to-patient ratios can vary widely, and in some cases, the facilities with really severe mental health exacerbations (including suicide attempts) cannot guarantee mental health assistance.

What limitations about this data on staffing should readers be aware of?

Nwadiuko: First, this data is from October 2019 to September 2022, so current data is needed.  That being said, staffing shortages persist: a 2025 government oversight report found that a facility hosting more than 700 detainees in Buffalo, N.Y. did not have a physician or dentist on site, and there might not be one available until 2026.

There’s also a real important disconnect between having a health worker assigned and having one available, which may make some of our estimates of provider availability overly generous. In 2022,a 39-year-old male died at the Denver Detention Center in Colorado from a pulmonary embolism after presenting for six weeks with unilateral leg pain and swelling—a sign of a preceding deep venous thrombus. Although the facility reported having a physician on site to congressional investigators auditing the facility, ICE investigations revealed that the patient was fully triaged three times—only by licensed practical nurses. 

What policy recommendations do you have based on this work?

Nwadiuko: First, there needs to be an improvement in health workforce staffing within facilities. Like correctional officer availability, it should be a limiting factor for facility operations—if they cannot meet minimum clinical staffing levels, they should not be open.  The average length of stay in detention is two months, and prior work has shown that 42% of immigrants in detention already have a health condition, so deterioration of health conditions can always become a concern. Second, patients with high-risk comorbid conditions should probably not be held in detention.

What’s next for you in this body of research?

Nwadiuko: We have received a very large trove of utilization data from Immigration and Customs Enforcement that we are currently trying to process. Hopefully, we can release the results soon.

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The article, “Health Workforce Staffing in Immigration Prisons,” appeared in Journal of General Internal Medicine on October 24, 2025. Authors include Joseph Nwadiuko, Erik Carrillo, Annette M. Dekker, Amy Zeidan, A. Katrina Nelson, Diana Simmes, and Parveen Parmar.

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