By Sheri Fink
A 7-year-old Guatemalan girl who died in United States custody last December was suffering from a bacterial infection that was so advanced she probably would have been visibly sick for many hours, said several physicians who reviewed a newly released autopsy report of her death.
By the time the girl, Jakelin Caal Maquin, arrived at a children’s hospital in El Paso with seizures and difficulty breathing, she already had severe blood abnormalities, according to a part of the report that summarized her condition in the emergency room of the Children’s Hospital at the Hospitals of Providence Memorial Campus.
The new findings were released on Friday by the El Paso County Office of the Medical Examiner. Customs and Border Protection officials and lawyers for the girl’s family have sparred over whether the severity of her infection — with a common streptococcus bacteria — should have been recognized and whether she should have been taken for medical care more quickly.
“Something like that takes hours to progress,” said Dr. Lee Sanders, the chief of general pediatrics at Stanford University.
Jakelin and her father, Nery Gilberto Caal Cruz, spent about eight hours in a remote area of the New Mexico border after they were apprehended by Border Patrol agents for crossing illegally into the United States as part of a group of 163 migrants. They were not placed on the first bus departing for the Lordsburg Border Patrol Station, according to a timeline released last December by Customs and Border Protection.
Officials said that Mr. Caal signed a form after he was apprehended that certified his child was healthy. However, lawyers representing Mr. Caal have said the form was in English, which Mr. Caal did not speak.
Many migrants interviewed in recent weeks after being released from Border Patrol custody said they or their children had been sick but they had not revealed the illnesses, for reasons ranging from fear that it would slow their processing to a lack of knowledge that medical care would be available. Pediatricians said that it would be difficult for Border Patrol agents with little or no medical training to judge how sick a child was.
Congressman Raul Ruiz, a Democrat from California who is an emergency physician, said in an interview that the new report highlighted the need for standardized medical checks at the border.
“Clearly there was no meaningful observation or evaluation of this child,” he said. “It is the legal responsibility of C.B.P. to provide for the humanitarian needs and the health needs of the children under their custody while being detained.”
That duty is made more challenging by the fact that migrants are crossing in difficult to reach areas, where medical resources, including ambulances, are in short supply.
The agency said Mr. Caal notified border patrol agents that his daughter was sick and vomiting only immediately before their departure from the remote region. Still, the girl did not receive medical attention until the bus arrived at the station, roughly an hour and a half later, where Border Patrol agents trained as emergency medical technicians examined her and called for an ambulance. She was then flown to the El Paso hospital.
Jakelin’s death, and then the death just weeks later of another Guatemalan child, Felipe Gómez Alonzo, led the federal agency to begin making improvements in evaluating children for medical problems and increase staffing of medical professionals. Congress has earmarked funds for that this year.
Lawyers for the girl’s family have called for an independent investigation, and said in a statement Friday that while the autopsy report “sheds some light on Jakelin’s cause of death, it still leaves many questions that require further review.”
“The report’s findings suggest that Jakelin’s chances of surviving would have been improved with earlier medical intervention,” they said in the statement. According to the autopsy, Jakelin’s death resulted from streptococcal sepsis, a life-threatening response to infection.
Mr. Caal said Friday evening that although he had been informed about the release of the autopsy report, he had not yet seen it.
“I wanted to know what happened,” he said, speaking by phone from Philadelphia where he is staying with relatives. He had been concerned that the report might in some way affect his immigration case.
The agency, which has defended its handling of the case, did not offer a comment on the new report.
At a news conference on Wednesday announcing further increases in illegal border crossings, Kevin K. McAleenan, the Customs and Border Protection commissioner, warned that dangers remained.
“With 55,000 families, including 40,000 children expected to enter the process this month, we are doing everything we can to simply avoid a tragedy in a C.B.P. facility,” he said. “But with these numbers, with the types of illnesses we’re seeing in the border, I fear that it’s just a matter of time.”
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