The court-appointed monitor said it plainly because the medical record would not let him say it any other way: the California City immigration processing center, the largest ICE prison in the state, lacks a reliable system to consistently provide adequate health care, placing individuals at serious risk of both immediate and long-term harm. He found the facility out of compliance in all eight areas a federal judge had ordered it to address — adequate staffing, timely screenings, primary care, specialist access, emergency response, intake follow-up, medication delivery, and the “sick call” system through which a detained person requests care in the first place. The pattern, he wrote, “indicates broader problems in the facility’s health care delivery system rather than occasional lapses in care.”
That is a doctor, retained by a federal court, hired because a federal judge found the lawsuit’s allegations credible enough to require independent verification, telling you the system is the harm. Not a sick guard on a bad shift. Not a contractor cutting corners to save a dollar. The whole architecture.
You have to make yourself read what the architecture does to the bodies inside it, because the agency will not.
Patients reporting a specific complaint receive an examination that does not document the body part related to the symptom — “the most basic step in evaluating a medical complaint,” the monitor wrote. Doctors write “WNL” — within normal limits — without specifying findings. A patient who uses a wheelchair is injured during transport to an outside facility, on two separate occasions, both incidents documented by staff. A patient with a disability is left in the shower area “for a long time” because no one is available to escort him back; he and others must rely on roommates instead of trained staff for help with basic activities. People taking medications for chronic disease stay up until two in the morning waiting for pills that were supposed to arrive around seven in the evening. The monitor found loose pills on the floor in a medication room. Cancer treatment is delayed. Insulin is denied. Psychiatric patients deteriorate until they are hospitalized, returned, deteriorate again.
This is the first court-ordered investigation of the full scope of medical care at any ICE facility in the United States. The doctor spent months reviewing 141 medical records, visited the facility for three days in May, and interviewed forty patients and staff. The result is a fifty-one-page clinical document in which the government’s own contractor cannot find a single category of care the facility actually delivers as a federal judge had ordered it to.
This is not a Texas story. It is not a 2018 story. It is California’s largest ICE facility as of 2026, and the conditions echo what advocates documented last month in a Texas ICE camp where nine in ten detained people reported being beaten. Different state. Same machinery.
A federal judge had given the government a chance to demonstrate compliance. The government runs the facility through CoreCivic, the private prison corporation whose Q4 2025 ICE revenue alone hit $244.7 million — more than double the $120.3 million from the same quarter a year earlier — and whose annual ICE revenue surged by 103 percent. CoreCivic reactivated the California City Immigration Processing Center as part of an ICE expansion whose bed target, according to internal documents, has reached at least ninety-two thousand beds, with some plans calling for more than one hundred thousand. The company is not a defendant in this lawsuit; the government is. Its spokesperson said “nothing matters more to CoreCivic than the health, safety and well-being of the people in our care,” then explained, as such spokespeople usually do, that the things actually breaking are someone else’s responsibility — “the scheduling, availability, and capacity of outside providers are not controlled by the facility.” A Department of Homeland Security spokesperson did not respond to questions about the monitor’s findings but maintained that it provides “comprehensive medical care” to detained people.
More than sixty-five thousand people are now in ICE detention nationally, a level that places enormous operational pressure on a system scaling rapidly. Staff were moved to clinical duties before finishing orientation. Staff who were not yet fully trained were tasked with training others — untrained people training untrained people. The intake process fails to catch urgent or serious conditions. The sick-call system is not responsive. Specialist referrals are missed, denied without documentation, or delayed past deadlines already noted in the patients’ own medical records. The monitor’s report is fifty-one pages. Its conclusion is that the place breaks the law in every category the judge asked him to check.
The monitor, Dr. Muthusamy Anandkumar, is not a hostile witness. He previously served as a medical expert for the Department of Homeland Security — the very department whose detention system he is now reporting on. He has a history of auditing ICE facilities and local jail healthcare systems. His review included 141 medical records, a three-day site visit in May, and interviews with forty patients and with staff. When the monitor says this is structural rather than episodic, he is saying what every detained immigrant who has tried to get a pill on time already knows: the system is not malfunctioning. The system is operating as designed. The design is what is wrong.
Tess Borden, the managing attorney at the Prison Law Office representing the detained plaintiffs, called the findings a “nightmarish story” — psychiatric patients left without follow-up, improperly stored medications and culture specimens, specialist appointments never scheduled or routinely missed. “This report confirms what thousands of people have experienced firsthand: in every area of health care, California City is failing.”
The law she is invoking through this litigation is the same law the Hebrew prophets named when they told Israel that the stranger, the widow, and the orphan must not be left to languish. Leviticus 19:34 makes the instruction precise: “When an alien resides with you in your land, you shall not oppress the alien. The alien who resides with you shall be to you as the citizen among you; you shall love the alien as yourself, for you were aliens in the land of Egypt: I am the Lord your God.” The moral logic of that commandment is not contingent on which administration is detaining which people. The commandment predates ICE by roughly three thousand years. It was written for precisely this circumstance — a powerful state treating foreigners as a category outside the protections owed to citizens — and it forbids the treatment as a category.
The Catholic bishops of the United States and Mexico said it as clearly as the prophets in their 2003 pastoral letter Strangers No Longer: refugees and asylum seekers should be afforded protection, and the human rights and human dignity of undocumented migrants should be respected. Pope Francis said it from Lampedusa in 2013, naming what was happening to migrants in the Mediterranean a “globalization of indifference.” Pope Leo XIV, the first American pope, said it plainly in a 2025 interview: when people have been living good lives in this country for ten, fifteen, twenty years, to treat them as this system treats them is to fail the test of whether we are, in any sense that should command respect, a pro-life people. The medical monitor is not making a theological argument. He is making the medical one. The two arrive at the same place by different roads.
A working intake screening would catch the diabetic, the cancer patient, the person on antipsychotics who needs inpatient care. A working medication system would deliver insulin on the schedule the prescription requires rather than at two in the morning after the patient has stayed awake to receive it. Trained escorts for a wheelchair-bound patient during transport would mean he does not come back injured a second time. A specialist-referral pipeline where the appointment actually happens and the reason for denial is documented. Sick calls answered when a person is sick. These are not innovations. They are the floor. The federal judge identified them as the floor. The monitor found every one of them missing.
The government has more than sixty-five thousand people in its custody on any given day now, more than at any prior point in ICE’s history, and a private prison industry with record revenues running the largest facilities. The system is not going to fix itself. Court orders will continue to be sought; some will be entered; some will be complied with, partially, for a while, until the next monitor files the next report. People will keep getting sick. Some will be hospitalized. Some will die. The contract will continue.
I write to the people who administer these places and the people who oversee the agencies that hire the contractors. You know what the monitor found. You knew before he found it. The doctor at California City confirmed what the people inside had been saying. Whether that confirmation changes anything depends on what you do with it in the room where your decisions are made.
The detained who are waiting tonight for the insulin that should have come at seven o’clock are not abstractions. They are not “the undocumented” or “this administration’s immigration enforcement challenge” or “a line item in a contract dispute.” They are people whose kidneys are failing, whose cancer is spreading, whose minds are coming apart because no one is giving them what a federal judge ordered and a court-appointed physician confirmed they must be given.
The door of return is open. It is always open. What you do with the doctor’s report is what tells whether the door means anything.