Medical Provider Vying for Border Contract Faces Scrutiny after Girl’s Death

The Washington Post / Nick Miroff

16:58 JST, November 20, 2023

A medical services company whose quality of care is a focus of a probe launched after the death of an 8-year-old girl in U.S. border custody has been selected as a finalist for a new $1.5 billion government contract, a Washington Post investigation has found.

Florida-based Loyal Source Government Services is among a half-dozen companies under consideration for the five-year contract to provide medical screening and services for the thousands of migrants detained each day along the southern border, according to three U.S. Customs and Border Protection officials and records obtained by The Post.

Loyal Source has been the primary medical services provider for CBP since 2020, and has obtained CBP contracts worth roughly $700 million since 2015, government records show.

The company has struggled for years to staff border facilities with nurses and doctors, often using lower-level emergency medical technicians earning a third of the pay or less, according to two current employees who spoke to The Post on the condition of anonymity because they could be fired for speaking to reporters.

Officials at CBP, which is conducting the investigation, say Loyal Source is the only company currently large enough to deliver medical services at the scale needed by the government. But medical officers and investigators at the agency have raised growing concerns about the quality and safety of that care.

CBP sent Loyal Source a letter Aug. 10 describing widespread problems with the company’s performance on its current $25 million-per month contract, including chronic staff shortages, excessive travel expenses and error-plagued record-keeping, according to two CBP officials who were not authorized to discuss the letter, which has not been previously reported. The warning, known as a cure notice, is the formal mechanism used by the federal government to alert contractors that they are at risk of suspension or termination.

CBP officials declined to discuss the notice. “The health and safety of individuals in our custody, our workforce, and communities we serve is a top priority,” the agency said in a statement to The Post. “CBP is dedicated to the ongoing review and evaluation of our practices to ensure that all individuals in our custody receive the best care possible.”

For decades, emergency care in Border Patrol stations was provided primarily by agents with basic medical training. The stations were designed to hold adult migrants for short stays, not families with children.

But with record numbers of people crossing the border – and many spending longer periods in U.S. custody – CBP has been under growing pressure to develop its own medical-care system. The agency urgently sought outside help after the deaths of several children along the border in 2018 and 2019.

Border Patrol stations in remote areas are the most difficult to staff. They present significant risks because smuggling organizations send large groups of families with children to those locations, a tactic used to overwhelm and distract U.S. agents. Migrants often arrive injured and dehydrated at those locations after walking long distances through rough terrain, the Loyal Source employees said.

One employee who has EMT certification said he makes about $20 an hour, up from $16.75 when he started. He said he is often the only medical-care provider at stations in Texas, New Mexico and Arizona where 200 to 300 migrants sometimes arrive during a single shift.

The agency also has employed certified nursing assistants with less training than EMTs, the employee said. “So many of them come from nursing homes having only worked in support roles, like changing bedsheets and things like that,” he said.

More than 2 million migrants were taken into Border Patrol custody during the 2023 fiscal year that ended Sept. 30, a historically high number for the second consecutive year. Record numbers of families with children have been crossing illegally, and the winter flu season creates added risk in crowded facilities where infections spread quickly.

Loyal Source’s performance came under greater scrutiny after CBP began investigating the death of 8-year-old Anadith Danay Reyes Álvarez, who was held in U.S. custody for nine days after crossing the border illegally with her family in May.

As Anadith, who was born in Panama, fell ill and her condition deteriorated, Loyal Source medical staff denied requests from her mother for urgent medical attention, according to CBP investigators and a court-appointed pediatrician who oversees care for migrant children in U.S. custody. The staff also mishandled records showing the girl had a heart condition and sickle cell anemia.

Despite those findings and rare public criticism of the company’s performance from CBP, Loyal Source was added last month to the shortlist of companies vying for the new contract. A CBP advisory board did not recommend Loyal Source for the next round of consideration, but the agency’s procurement office overruled the board’s findings, according to the three CBP officials, who spoke on the condition of anonymity because they are prohibited from discussing the selection process.

The contract selection was structured in a way that a company’s past performance could not be considered as a factor during the first phase, but it will become a part of the process in the second phase, the officials said.

In a statement, CBP declined to respond to questions about the contract selection, citing “procurement sensitive information.”

“CBP is intensely focused on ensuring that the procurement process is conducted correctly and with the utmost integrity and professionalism,” the statement said.

CBP’s Office of Professional Responsibility, the agency’s internal affairs division, continues to review Loyal Source’s business practices and performance record, after assigning what is known as a “tiger team” of auditors, according to the three officials with knowledge of the probe. The investigators have recommended the suspension of Loyal Source’s current contract, two of the officials said.

Brian Moore, the CEO of Loyal Source, declined requests for comment on the CBP investigation, the Aug. 10 cure notice and his company’s track record, referring inquiries to CBP.

“Loyal Source is prohibited from responding to media inquiries regarding our CBP contract,” Moore wrote in an email.

The $1.5 billion medical contract, which officials say will be among CBP’s largest ever, has become an albatross for the agency after more than a year of administrative delays and disputes. CBP officials said they are especially anxious about discussing the contract publicly because the selection process has already triggered so many procedural challenges.

In September 2022, CBP tried to award the contract to another firm, Texas-based Vighter, but Loyal Source and other competitors filed protests to the Government Accountability Office alleging unfair treatment and procedural flaws.

CBP amended its contract requirements after the protests, but Loyal Source filed additional challenges to the GAO, the federal entity that arbitrates contract disputes. The GAO denied Loyal Source’s protests in March, saying CBP had “acted reasonably and within its discretion.”

GAO records show Loyal Source and at least one other company filed new protests Nov. 3. The notices do not indicate the basis for the challenges.

In the meantime, CBP continues to rely on Loyal Source for medical services as part of a sole-source contract extension due to expire at the end of December. In Border Patrol stations staffed with EMTs or health aides, higher-paid doctors and nurses are available for phone consultations. Those providers, however, are often located in other states and don’t always respond to calls, the two current Loyal Source employees said.

In recent months, Loyal Source managers have expressed alarm at high numbers of employees calling out sick and failing to report for shifts, warning that they will face termination, according to internal emails obtained by The Post. Group messages among Loyal Source employees show pleas for help from staff who say they are the sole medical provider on duty and need backup.

A Loyal Source employee working in California said the company’s staffing shortages would improve if the company offered bonuses and better pay. “The solution to filling shifts at these stations in the middle of nowhere is not that hard,” the employee said. “Just pay $2 more per hour and I promise you the stations would be staffed.”

Anadith Reyes Álvarez, whose parents are from Honduras, was diagnosed with influenza after five days in U.S. custody. She and her family were transferred to a Border Patrol station in Harlingen, Tex., that was designated as a medical isolation ward run by Loyal Source.

Mabel Álvarez Benedicks, the girl’s mother, told reporters that Loyal Source medical staff refused more advanced care as her daughter grew sicker and begged for her life.

“Only after [Anadith] lost consciousness and suffered an apparent cardiac arrest was an ambulance called,” wrote Paul Wise, the Stanford pediatrician appointed as an independent monitor for migrant juvenile care, in a report to the federal court system in July.

Wise called the child’s death “clearly preventable” in his report. CBP investigators described “failures” by the Loyal Source staff and said the closed-circuit video system in the border station was not working at the time of the incident.

CBP responded to Anadith’s death by banning several Loyal Source staff members from its border facilities. In June, the Department of Homeland Security reassigned CBP’s top medical officer and replaced him with Alexander Eastman, a senior DHS medical official.

A DHS medical team that investigated the child’s death told CBP in June that the health-care system run by Loyal Source was unsafe and needed systemic changes. CBP officials said they have undertaken steps to ensure medically fragile people receive quality care.

The agency “will continue to review procedures, practices, and equipment,” including prioritizing families for faster processing to minimize the amount of time children spend in U.S. custody, according to the statement.

The GAO has 100 days to rule on the latest protests. Unless the GAO agrees to fast-track its rulings, CBP will have to wait until next year to announce the new contract, one official said, and Loyal Source will remain on the job.