P3.214: RELEAASED: REsidents Learning and Exercising Advocacy for Asylum SEekers in Detention

Background: The UN Refugee Agency memo on release from immigration detention in the US designates that individuals may seek humanitarian parole for provision of emergency medical care. Letters from medical professionals often serve as evidence of the urgency and legitimacy of such requests . An Immigration and Customs Enforcement detention center exists one mile from the University of Colorado (CU) Anschutz Medical Campus and detains an estimated 1,142 people.
In 2020, CU Med-Peds residents began writing letters supporting humanitarian parole in partnership with the Denver Health Forensic Asylum Program.

Project Description: Legal representatives request letters through a REDCap survey. Resident project leaders follow up with the requestor to clarify medical concerns. Resident volunteers review medical records of people who are detained and draft letters to the court detailing health care conditions and needs, as well as how these conditions may confer additional risk while in detention. Attending leadership cosigns all letters. Demographic and outcome data are tracked in REDCap.
In total, 36 letters have been requested. The most common birth countries were Mexico and Guatemala.
Of those requested, letters were written for 28 detained people. Fifteen people were released from detention, eight were deported, and five remained in detention or were lost to follow-up. Most cases for which letters were requested but not written were either referred for DH forensic evaluation or lost to follow-up.
In 2020–2021, letters focused on the heightened risk of COVID-19 infection and sequelae among people with medical comorbidities who were in detention. After 2021, letters addressed medical care needs including cancer and mental health treatment. Some letters have been written in lieu of a forensic evaluation if hearings were imminent. Recently, more letters have been written to advocate for medical care for individuals while in detention.
Eleven resident physicians wrote letters, predominantly med-peds residents at all stages of training. Six primary care attendings and one social worker also wrote letters.

Discussion: This initiative demonstrates the impact of resident advocacy in addressing the needs of individuals in detention through medicolegal partnership. Program successes include increased cross-institutional collaboration, longevity, outcomes tracking, and release of individuals needing urgent medical care. Importantly, the project has also taught residents about immigration law and the provision of health care in detention centers. Lessons learned include the importance of role clarity when collaborating with legal partners and the scope of practice for clinicians writing these letters. Future directions could include partnership with peer institutions on similar work and resident involvement in forensic exams.

Conclusion: The five-year outcomes of the Denver Health Forensic Asylum Program / CU Med-Peds humanitarian parole letter initiative demonstrate a sustainable model for resident-driven advocacy. This serves as an example for future advocacy efforts focused on the human rights of individuals in immigration detention.