Jose Guadalupe Ramos’ cellmates inside a distant Immigration and Customs Enforcement detention heart in Southern California might see that he desperately wanted assist.
Ramos, who was struggling to breathe, turned purple and his eyes rolled again in his head, recalled Marco Martinez, who stated he slept in the bunk subsequent to Ramos.
But as Ramos’s fellow detainees screamed for assist, it took 10 minutes for medical staffers to reply, Martinez stated. When they did arrive, nurses struggled with a malfunctioning oxygen tank as they tried and did not revive Ramos, he stated.
The 52-year-old, who had lived in the US for almost three a long time, was lined with a blanket and carried out on a stretcher, Martinez stated of the March 25 incident. He was quickly pronounced lifeless.
“I don’t want to accept it,” stated his widow, Antonia Tovar, who lives with their two kids in the identical Los Angeles-area home the place she and Ramos had been married 29 years in the past. “I still feel like one day he’s going to come back.”
Ramos is certainly one of almost 50 ICE detainees who has died since President Donald Trump returned to workplace final yr and started pushing for mass deportations. More died in custody in 2025 than in any yr in a minimum of 20 years, and 2026 is on observe to be even greater.
Many of the deaths seem to have been preventable, a NCS investigation discovered. Deadly outcomes in greater than a dozen circumstances might be linked, in half, to substandard remedy by at-times understaffed medical groups coping with escalating detainee populations, in line with a assessment of post-mortem stories, court docket data and interviews with detainees and consultants.
NCS additionally discovered that failures by the Department of Homeland Security and its contractors have helped to drive that lethal pattern. Even as Trump’s insurance policies swelled detainee populations above deliberate capability limits at some detention centers, medical staffing numbers didn’t rise in some key ICE services.
DHS and its contractors have been opaque about medical care inside detention centers – usually declining to launch info just like the variety of medical staffers available to state investigators, lawmakers or the press. DHS and the 2 largest contractors, GEO Group and CoreCivic, declined NCS’s request for these figures.
A brand new report from the California legal professional common’s workplace, solely shared with NCS, sheds mild on circumstances inside some centers – together with the Adelanto ICE Processing Center, which held Ramos and three different detainees who died since early 2025. Although Adelanto and a neighboring facility held greater than 2,000 detainees in July, fewer physicians and superior practitioners labored there than in February 2021, once they held fewer than 100 detainees, the report stated.
A state inspection group additionally discovered “crisis-level health care understaffing” at one other detention heart in the state and concluded that medical employees at a number of services usually did not conduct required screenings and didn’t give detainees with continual and acute circumstances referrals for correct care.
Those staffing shortfalls had been exacerbated by DHS insurance policies, together with a directive that discouraged early launch of aged and sick detainees, and the gutting of oversight workplaces meant to flag security dangers and assist maintain immigration officers and contractors accountable for missteps.
In an announcement, a DHS spokesperson stated that ICE supplies all detainees with correct medical remedy and that detention services will not be overcrowded. The spokesperson argued that there has not been a spike in deaths in custody.
“As bed space has rapidly expanded, we have maintained higher a standard of care than most prisons that hold US citizens—including providing access to proper medical care,” the spokesperson stated. “For many illegal aliens this is the best healthcare they have received their entire lives.”
A spokesperson for GEO Group didn’t reply questions on Ramos’ loss of life and medical remedy, however stated in an announcement that the corporate’s services present detainees with “around-the-clock access to medical care” and are “independently accredited” by business teams. CoreCivic stated that it’s “committed to providing safe, humane and respectful care” and adheres “to all applicable federal detention standards,” and that it adopted all guidelines on facility capability.
As DHS prepares to extend migrant arrests and detentions this yr, consultants warn that preventable deaths in ICE services are more likely to proceed to rise except sweeping modifications are made.
“As you expand the system overall, you’re just putting more pressure on all of it,” stated Claire Trickler-McNulty, a former ICE official who helped craft detention insurance policies in earlier administrations. “Filling any facility to capacity is going to exacerbate a lot of problems – and they were filling a lot of them over capacity.”
As the Trump administration has reported a surge in immigration arrests, it’s additionally made modifications to make sure fewer of these detainees might be launched whereas their circumstances drag on.
Previous administrations had restricted the detention time of immigrants with critical well being points. An Obama administration ICE memo stated that the company ought to solely detain aged or sick immigrants in “extraordinary circumstances,” and the Biden administration’s ICE tips stated officers might take into account “declining enforcement action” on account of “advanced or tender age” or “a physical or mental condition requiring care or treatment.”
But Trump final yr shortly signed an executive order geared toward accelerating detentions that rescinded earlier ICE directives.
In July, a memo from ICE’s appearing director instructed company personnel to detain immigrants “for the duration of their removal proceedings.” The variety of immigrants launched on parole or bond has dropped precipitously in the next months, consultants say.
While native ICE management used to have discretion to launch detainees, now the company’s director should log off, present and former ICE workers advised NCS. “The pressure is to keep people in longer,” stated Trickler-McNulty.
In response to questions in regards to the policy modifications, the DHS spokesperson stated that the administration is “now enforcing the law as it was actually written to keep America safe.” They argued that “being in detention is a choice” as a result of undocumented immigrants might self-deport.
The outcome has been an older and sicker detainee inhabitants, in line with NCS’s evaluation of ICE information printed by the Deportation Data Project. Only about 800 individuals estimated to be 65 or older had been booked into ICE detention over the last yr of Biden’s presidency, in comparison with about 2,500 individuals in the primary yr of Trump’s second time period.
George Zoley, the CEO and chairman of the GEO Group, acknowledged throughout an earnings name final week that the corporate’s services had been holding extra detainees in poor well being.
“We’re seeing a population that, I’m told, is more sickly than we’ve historically had, and these people require more off-site visits, require more staff involvement, more overtime expense,” Zoley stated.
As Trump’s mass deportation push gained steam, the variety of individuals in ICE detention spiked to greater than 55,000 in June – the best on file since a minimum of 2008, in line with information from the company. It reached over 70,000 by January.
Populations in some ICE services have greater than quadrupled over the course of simply days or even weeks.
Yet as detainee numbers rose precipitously this yr, it’s not clear precisely how DHS or its high contractors have invested in extra medical employees to take care of that inhabitants.
Acting ICE Director Todd Lyons stated earlier this month that the company has “invested almost half a billion dollars in detainee healthcare this year alone,” although he didn’t element how that cash was spent.
“They get better care than some people in our poorest communities in some of our states,” Lyons stated.
ICE services are required underneath company guidelines to rent sufficient medical employees to supply well being screenings, emergency care and different medical help for detainees – though the requirements don’t lay out a selected ratio of medical staffers per detainee.
The California legal professional common’s workplace examined seven detention centers in the state – 4 run by GEO Group, two by CoreCivic and one by Management & Training Corporation (MTC).
Their report discovered that some ICE detention centers had seen will increase in medical employees in 2025 in comparison with earlier years, whereas different services struggled with drastic understaffing and had routinely failed to supply ample care.
“If the federal government is going to be surging its ICE enforcement and detaining more and more Californians and putting them in these facilities, they need to provide them the basics,” California Attorney General Rob Bonta stated in an interview. “If you have more people, you need more staff. That’s obvious.”
The report famous that Adelanto’s July 2025 medical staffing fell wanting what it had in February 2021, when the power housed simply 79 detainees, however employed three full-time physicians and 5 superior practitioners.
In interviews with state inspectors, Adelanto employees stated they had been “caught off guard” by the surge in detainees. GEO Group’s regional well being companies director advised the California assessment group they’d employed 5 registered nurses and 5 licensed vocational nurses, and had 20 extra nurses present process background checks.
State inspectors famous that at Adelanto solely a couple of fourth of detainees they interviewed reported receiving a complete well being evaluation inside 14 days of their arrival, as required by ICE requirements. Detainees described ready weeks to get remedy for points reminiscent of an ear an infection or a damaged wrist.
In a class-action lawsuit filed in January, detainees at Adelanto raised comparable issues. One detainee, Andrei Karamychev, described ready two months to be seen by nurses, who advised him they’d simply three individuals to course of greater than 500 sick calls. Another detainee, Josue Jeison Pereira Amaya, stated an Adelanto physician advised him he might solely get ibuprofen after experiencing discomfort from a surgical procedure that sometimes required stronger painkillers.
“It is not safe to be sick at Adelanto,” Altaf Saadi, a neurologist who served as a medical professional for the plaintiffs, wrote in a court docket declaration.
A senior ICE official stated in a declaration in response to the lawsuit that the majority detainees who spoke with inspectors shared no complaints about medical care and a 2025 inspection discovered the power met the overwhelming majority of requirements.
A former senior ICE official, who requested to not be named so they might communicate candidly in regards to the state of affairs, acknowledged to NCS that some services have, through the years, “struggled to be able to stay at full staffing in medical.”
On January 23, 2025, Genry Ruiz Guillen, a 29-year-old immigrant from Honduras, turned the primary individual to die in ICE custody throughout Trump’s second time period. By yr’s finish, 31 detainees had died, and this yr, the speed has picked up velocity, with 18 lifeless since January.
The improve in deaths isn’t simply due to the soar in the detainee inhabitants. The detainee loss of life charge rose in fiscal yr 2025, which covers October 2024 by September 2025, and is on observe to rise even greater in the present fiscal yr, in line with a research published in the Journal of the American Medical Association final month.
The DHS spokesperson objected to the research’s conclusions, arguing that “consistent with data over the last decade, as of April 30, death rates in custody under the Trump administration are 0.009% of the detained population.” The company had beforehand claimed a good decrease charge, writing on social media in January that the loss of life charge was 0.00007%.
NCS obtained county medical expert stories for the overwhelming majority of the deaths since early 2025, with assist from the Project on Government Oversight (POGO), a nonpartisan unbiased watchdog, and the American University Investigative Reporting Workshop. Through these stories and interviews with relations and consultants, NCS discovered a minimum of a dozen deaths that higher care might doubtlessly have prevented by earlier analysis, swifter responses to emergencies, or different components.
Huabing Xie, 53, advised a nurse at his consumption examination on the Imperial Regional Detention Facility in Calexico, California, in September that he had a historical past of hypertension. Yet in line with ICE’s report, it took 11 days for a medical staffer to prescribe treatment for Xie, who died of an enormous coronary heart assault 5 days after the treatment was prescribed.
The California legal professional common’s report famous that Imperial, which is operated by MTC, failed to present complete well being screenings to most inmates interviewed by investigators, and that just one part-time doctor labored there on the time of the location go to.
MTC stated in an announcement that its services adhere to “nationally recognized standards for health care and facility operations” in addition to ICE laws, and referred questions on Xie’s loss of life to DHS.
In some circumstances, the medical-examiner probes obtained by NCS appeared to contradict statements in the ICE stories in essential methods.
Maksym Chernyak, 44, had immigrated from Ukraine underneath a Biden-era humanitarian program for individuals displaced by Russia’s invasion. He was arrested in Fort Lauderdale, Florida, in January after a home dispute together with his common-law spouse that she described as a misunderstanding, exacerbated by a language barrier with law enforcement officials.
After about two weeks contained in the Krome detention heart in Miami, Chernyak had a medical emergency that ICE later described as “seizure-like activity.” He was rushed to a hospital, the place testing revealed he had a attainable stroke. Chernyak was pronounced lifeless two days later. The ICE report stated the consumption nurse at Krome famous Chernyak’s “negative history of any medical conditions” and solely flagged “slightly elevated blood pressure.”
But the Miami-Dade County medical expert’s investigation, accomplished on the day of Chernyak’s loss of life, revealed that he had a historical past of hypertension and stated he’d beforehand taken medication to deal with excessive ldl cholesterol and forestall coronary heart assaults or strokes. Neither the hypertension nor the treatment was talked about in the ICE report. There is not any indication that treatment for his situation was administered on the detention facility.
Emmanuel Damas, a 56-year-old asylum seeker from Haiti, was taken into custody whereas dealing with felony fees of assault and battery. He complained to relations a couple of toothache on February 17 whereas detained on the CoreCivic-operated Florence Correctional Center in Arizona, his brother, Presly Nelson, advised NCS. Two days later, he was rushed to a close-by hospital, the place he died of septic shock on March 2 because of the an infection, Nelson stated.
ICE made no point out of the toothache in its initial statement, launched a couple of days after his loss of life, saying he was despatched to the hospital after reporting shortness of breath. It later issued a revised report that talked about dental ache and, in addition to reporting that he demonstrated “confusion and difficulty following questions” throughout his consumption screening, stated he obtained common medical and dental evaluations.
Nelson disputes that. He advised NCS he discovered by one other detainee that Damas had been complaining about his tooth for 2 weeks earlier than he was despatched to the hospital and that the medical employees on the detention facility solely supplied him ibuprofen.
“You could expect those kinds of things for a small … country,” he stated. “But here, having access to a dentist is not a big deal.”
The DHS spokesperson stated that on January 8, Damas refused dental extraction and claimed his tooth didn’t damage anymore, and that when he was seen once more on February 12 for dental points, he once more refused a advice that two tooth be extracted.
A CoreCivic spokesperson declined to debate particulars of Damas’ case, citing privateness legal guidelines and stated they had been dedicated to offering care to all detainees.
NCS’s evaluation discovered that aged detainees are dying extra usually underneath the Trump administration – 5 have died in detention since January 2025, already greater than in Joe Biden and Barack Obama’s phrases mixed. Isidro Perez, who died at 75 in June after struggling coronary heart issues inside Krome, was the oldest detainee to die in ICE custody since 2006.
At least half of those that died since January 2025 both had been described in ICE loss of life stories as having a standard continual medical situation or had been aged; underneath the Biden administration’s 4 years, solely 15% of deaths match these metrics.
Ramos was arrested by ICE in February after reporting to a courthouse as a part of a diversion program from a quotation for theft and possession of a managed substance, in line with court docket paperwork. Prior to that case, he’d lived almost three a long time in the US with no felony file, working at an industrial laundromat to help his household.
Martinez, his cellmate, stated Ramos had been receiving each day insulin pictures and different drugs to deal with his diabetes and hypertension.
According to ICE’s public detainee loss of life report, a registered nurse arrived one minute after a guard first observed Ramos in medical misery and started offering medical help, and emergency staffers arrived 10 minutes later. Ramos was transferred to a close-by hospital, and a doctor declared him lifeless three minutes after he arrived, the report stated.
But Martinez alleges that employees had been unable to adequately present Ramos with emergency care. He stated a guard ignored requires assist for about 5 minutes, and that nurses took one other 10 minutes to reach, by which period Ramos gave the impression to be in extreme situation. The staffers tried to make use of an oxygen tank to assist Ramos, however they couldn’t open the nozzle, he stated, including that the tools seemed outdated. They ended up giving Ramos CPR to no avail.
Martinez additionally stated Ramos gave the impression to be lifeless in the cell earlier than he was taken to the hospital.
The DHS spokesperson stated that Adelanto safety employees “immediately called onsite medical staff, who initiated life saving measures, including CPR” and that employees “immediately called emergency services, who swiftly responded to the scene and initiated advanced life support interventions.” A GEO spokesperson declined to reply particular questions on Ramos’ loss of life and Martinez’s claims.
Martinez, who stated he thought of Ramos like a father to him in the detention heart, stated he was nonetheless combating the loss.
“Every day I wake up just looking at his bed and I’m just like, oh man – I can still see him laying there,” Martinez stated. “I have a heart attack or if I have stroke, that’s pretty much it. I even have my goodbye letters written.”
As Trump’s mass deportation push continues, DHS acquired almost a dozen huge warehouses across the nation to convert into new detention and processing centers – a plan that critics warn might result in a bunch of medical remedy challenges. The effort was paused final month pending additional assessment by DHS officers.
Rep. Delia Ramirez, a Democrat who represents a Chicago-area district, stated that if the plan strikes ahead, it might result in “thousands and thousands of people warehoused with no medical care, with not adequate staffing, with inhumane conditions.”
Ramirez stated DHS officers have stonewalled her makes an attempt to get extra details about the company’s medical remedy requirements. She referred to as for unbiased investigations into deaths in ICE custody, arguing that the spate of deaths is “happening because DHS has no interest in any real accountability and transparency.”
Jonathan White, a former commander with the US Public Health Service Commissioned Corps, stated staffing up large-scale detention services is tough – requiring contractors to quickly rent and practice new staffers to maintain inmates secure.
“It creates health risk, physical danger, risk to those sheltered, to rapidly expand emergency capacity,” White stated. “It’s an incredibly high-risk activity to rapidly expand when you’re getting pressure from the top, from the White House, to grow big fast.”
Ramos’ household stated they’re nonetheless in shock from the lack of a father who they remembered for his love of cooking and creative ceviche recipes.
“We want justice,” stated Tovar, his widow. “Let justice be served, because my husband did not deserve to die.”
NCS’s Jack Hannah contributed to this report.