As It Happens

Autopsy of migrant child points to 'subhuman' U.S. border conditions, says lawmaker

After an autopsy revealed that 7-year-old Guatemalan Jakelin Caal Maquin died of bacterial infection while in U.S. custody, Congressman Raul Ruiz is drafting legislation to address what he calls the "inhumane" treatment of asylum seekers in custody.

'No clear guidance or guidelines' in border medical response, says Congressman Raul Ruiz

Claudia Maquin shows a photo of her daughter, JakelinCaal Maquin in Raxruha, Guatemala, on Dec. 15, 2018. The seven-year-old girl died in a Texas hospital two days after being taken into custody by border patrol agents in New Mexico. (Oliver de Ros/Associated Press)
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Jakelin Caal Maquin was just seven years old when she died in the custody of U.S. Customs and Border Protection last December, after having traveled more than 3,000 kilometres from Guatemala with her father. She was one of two children to die in U.S. custody that month.

On Friday, an autopsy report showed that she died from the bacterial infection streptococcal sepsis. Physicians are now saying that Border Protection workers should have seen the signs that she was seriously ill.

One of those physicians is Raul Ruiz. He's also a Democratic congressman representing the 36th district of California. He spoke with As it Happens host Carol Off from Washington, D.C. Here is part of their conversation.

Congressman Ruiz, what does the autopsy report reveal about how this little girl died?

The autopsy reveals that she died from a very severe sepsis, caused by streptococcal bacteria that led to multi-organ failure — which eventually led to her demise through a cardiac arrest that was unsuccessfully resuscitated in the emergency department.

Congressman Raul Ruiz, D-California. (Alex Brandon/Associated Press)

And what kind of care did she receive when these symptoms first presented themselves?

Well, that's the question, right? The question is when did she have these symptoms, and why was it that ... the CBP (Customs and Border Protection) was not able to identify certain symptoms? The problem is that there was no clear guidance or guidelines — no meaningful health screening or evaluation that was done upon her arrival. 

It is very unlikely that Jakelin looked normal eight hours before she went into a coma, had seizures and had respiratory failure. It's very rare that an infection can take a person who looks normal, and then eight hours later die.

In their statement, they say that the Border Patrol agents did everything in their power to provide emergency medical assistance to Jakelin, immediately after her father notified agents of her distress.... Was it his responsibility to have told them earlier?

Look, I'm an emergency medicine physician. I'm also trained in humanitarian disaster aid. And I practiced emergency care, humanitarian aid in emergency departments — out in the field, within our country, and after big disasters in Haiti as well as the very impoverished areas like in Chiapas, Mexico.

And I can tell you that ... they're mincing words, they're misleading, in a lot of respects — because there were no basic questionnaire or review of recent experience, or signs and symptoms that could have led to them identifying that Jakelin was sick. There wasn't even any vital signs taken, or any physical examination or any consultation with a care provider.

A boy carries a picture of Caal, as her coffin is taken from Raxruha to the cemetery in San Antonio Secortez on Christmas Day, 2018. (Johan Ordonez/AFP/Getty Images)

When I visited the stations and evaluated the paramedic bags, and any kind of equipment to resuscitate children or even to treat children, they did not have any medications for infants or toddlers. They did not have the appropriate I.V. tubing, or resuscitative equipment for infants and toddlers.

And so, although Jakelin was not an infant or toddler, it just goes to show you that they do not have the capacity, nor the know-how, nor the training on how to handle these situations. So that statement is is not completely accurate.

When you visited the border patrol facility where Jakelin was detained, what did you see? What was it like?

I saw conditions that were subhuman, and that lack the basic respect for human dignity. I saw many infants, toddlers, women and elderly cram-packed into a cold, windowless concrete room — where they were so packed that you couldn't see the floors. We had infants without diapers soiling themselves. You had elderly coughing, children coughing, in that room.

There were open toilets without privacy. People did not have the capacity to freely move, to go to a sink where there was soap, so they can wash their hands. They lacked basic foods — like baby formula, or baby food or any age-appropriate foods for the elderly. So there [were] very substandard conditions that lacked basic principle of human dignities.

And that's why I'm working to introduce legislation that will create a set of humanitarian standards that CBP would be legally required to abide by.

Vital signs, physical examination by trained health-care professionals — whether it be a nurse, a P.A., a medic or somebody who knows what they're doing, and can identify risk factors in who's sick and not — and then have a system where they can back that up with a professional who can then determine whether they need a specific treatment protocol while in custody, or they need to be evacuated immediately.

The other thing is looking at shelter. It is very subhuman to keep so many people packed together with limited space, with the lights on all night in freezing cold temperatures — with noises throughout the night which keeps them from sleeping — which were the cases in many of the stories that we heard throughout our our interviews.

A makeshift altar in honour of Jakelin Caal, at her home village of San Antonio Secortez, 320 km north Guatemala City. (Johan Ordonez/AFP/Getty Images)

And therefore, this piece of legislation would require CBP to provide a certain amount of space — in fact two-by-two metres per individual — and that would respect the temperature the sleep of asylum seekers.

We heard from President Trump on Friday, who said that Jakelin died because her father didn't give her water for a long time.

That is a flat-out scapegoating political lie — trying to point the finger at somebody else and not taking responsibility as the leader of our country, and the head administrator of the CBP to play the partisan game. And it is sickening, it is unconscionable, it is void of any ethos or morality.

And he should own up, be the president of the United States, take responsibility and come up with some solutions instead of playing the blame game. There's nowhere in any leadership course, or any discussions, or any book that you read where leadership is about blaming the most vulnerable for mistakes that occur.

Interview produced by Allie Jaynes. Q&A edited for length and clarity.