Olubunmi Joshua, a 54-year-old dual citizen of the United Kingdom and Nigeria, died at the Rolling Plains Detention Center in Haskell, Texas on October 24, 2016 after nearly nine months in the custody of Immigration and Customs Enforcement. The cause of her death was a heart condition caused by high blood pressure.

On the night of Joshua’s death, a mouse ran loose among the bunks in her housing unit, and a chase ensued. Rolling Plains, which was operated by the for-profit firm Emerald Correctional Management, had been repeatedly cited for health and safety violations, so perhaps it’s not surprising that it fell to the detainees to trap the rodent. Amid screams and laughter, Joshua killed the mouse, and asked for a plastic bag to deposit it. She shook the bag open, then suddenly fell backwards on the floor. She never regained consciousness.

Joshua, who was born in the United Kingdom and raised in Nigeria, came to the U.S. on a student visa when she was 22, and remained for 32 years. She lived in Texas and raised two children — a son who is a student at the University of Texas at Arlington, and a daughter who is a certified public accountant in Washington, DC.

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Joshua entered detention after she was arrested in Flower Mound, Texas, about 30 miles from Dallas, for driving without a license.

The medical care Joshua received for high blood pressure, anemia, anxiety, dental pain and other conditions was delayed, denied or mishandled by Rolling Plains’ medical staff, according to the official ICE report on Joshua’s death, known as a Detainee Death Review (DDR).

Among its findings:

— Blood pressure checks, ordered daily on two occasions, were done only sporadically.

— Nurses failed to check for cardiac problems when Joshua’s blood pressure was high, as protocol dictates.

— A psychologist suggested Joshua be prescribed psychiatric meds for anxiety and depression. Rolling Plains didn’t offer anti-anxiety drugs, and a medical doctor decided she didn’t need them.

— Joshua was anemic, but wasn’t given iron supplements until two months after her diagnosis.

An ICE spokesman didn’t address specific questions about Joshua’s care; he wrote in a statement that the agency is committed to maintaining high standards “for the safety and well-being of the detained aliens.”

The ICE review also found the detention center lacked sufficient medical staff, and that nurses performed tasks for which they weren’t licensed or trained.  The reviewers further discovered that the facility’s emergency medical kit was missing a defibrillator, delaying the proper emergency response when Joshua fell and lost consciousness on the night of her death.

However, ICE reviewers failed to identify another serious error in Joshua’s care, said Dr. Marc Stern, a physician and correctional health expert, who previously served as health services director for the Washington State Department of Corrections, and examined Joshua’s DDR.

Two months before her death, Joshua reported that her legs were swollen. “This is a new problem and makes me think her heart was starting to fail,” Stern said. “The swelling could have been caused by the heart’s inability to pump sufficiently. This is a critical moment.” But medical staff didn’t investigate whether cardiac issues caused the swelling. Instead, a nurse advised Joshua to elevate her legs – standard advice for swelling caused by standing for long periods of time, but potentially dangerous if swollen legs are the result of a bad heart. In that case, raising the legs would send additional fluid to the heart, placing greater strain on it.

Stern said the reviewers’ comments indicate they failed to understand the complexity of her case, and thus, to get to the core of what went wrong. “Someone else is likely to die at that facility because they never adequately figured out the problem. You can’t fix what you can’t identify.”

But known issues were also a factor in the inadequate care Joshua received. More than a decade before her death, the Rolling Plains facility failed two state inspections. Violations included failing to provide prescribed medicines. And, as recently as May, 2016 ICE inspectors discovered, along with other deficiencies in health care, that a Rolling Plains detainee whose blood pressure reading met American Heart Association guidelines for hypertensive crisis had not received medication. The inspectors reported they’d solved the problem; the detainee in question would receive medication and chronic care treatment.

Joshua, however, did not. Rolling Plains medical staff continued its on-again, off-again treatment of her high blood pressure and other health problems.

In the final 24 days of her life, she received only a little more than half of the blood pressure medication she was prescribed, ICE reviewers said. Several of Joshua’s requests for medical care went unanswered. The dental pain she’d reported in January had been ignored for eight months; the dentist she finally saw, four days before she passed away, discovered broken teeth and two gum abscesses. The pain and the infection, along with her poorly treated anemia, would have placed additional stress on Joshua’s heart, Dr. Stern said.

“It’s hard to tell,” said Stern, if the inadequate care Joshua received contributed to her death because of insufficient information in the ICE review.

“I see smoke. I don’t know if there’s fire. If I were the next of kin, I’d say I should try to get more information,” he said.

This reporting was supported by a grant from the Fund for Investigative Journalism.

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