For the second time in three weeks, a child detained by US Customs and Border Protection has died while in custody. The USCBP commissioner declared that “we need a new approach” to juvenile detainees, ordering pediatric evaluations of all children detained for crossing the border. That will almost certainly not satisfy critics of the Trump administration who put the responsibility for the deaths on their aggressive arrest and prosecution policies:

U.S. Customs and Border Protection ordered medical checks on every child in its custody Tuesday after an 8-year-old boy from Guatemala died. It was the second death of an immigrant child in the agency’s care this month. …

The boy, identified by Congressman Joaquin Castro, D-Texas and Guatemalan authorities as Felipe Gómez Alonzo, had been in CBP’s custody with his father, Agustin Gomez, since December 18. CBP said in a statement late Tuesday that they entered the U.S. three miles west of a legal entry point — the Paso del Norte bridge connecting El Paso and Juarez, Mexico.

CBP said an agent first noticed the boy had a cough and “glossy eyes” at about 9 a.m. Monday. He was eventually hospitalized twice and died just before midnight, the agency said.

The New York Times reports that the circumstances around this latest death are still somewhat murky. The child didn’t lack for medical attention, however, which raises questions about the efficacy of universal screening. This child not only got two such screenings at a local ER, he also got prescribed antibiotics and ibuprofen:

At first, the boy was thought to have a cold, but staff at the hospital, the Gerald Champion Regional Medical Center, later found that he also had a fever, according to the agency.

He was held at the hospital for an additional 90 minutes for observation and then released on Monday afternoon with prescriptions for amoxicillin, a commonly prescribed antibiotic, and ibuprofen, which is often used for relieving pain and reducing fever.

On Monday night, however, the boy grew nauseated and vomited, prompting border authorities to take him back to the hospital, where he died. …

The other migrant child from Guatemala, Jakelin Caal Maquin, died this month in United States custody in New Mexico. Border Patrol said Jakelin had died from dehydration, but her father, Nery Gilberto Caal Cruz, disputed that assertion, saying he “made sure she was fed and had sufficient water.”

Yesterday, USCBP commissioner Kevin McAleenan ordered immediate changes to policy and procedures in response to the second death, which he called a “tragic loss”:

• First, Border Patrol is conducting secondary medical checks on all children in CBP care and custody, with a focus on children under age 10.
• Second, Border Patrol is working with Immigration and Customs Enforcement on surge options for transportation to Family Residential Centers and supervised release, CBP said. The agency also is reviewing other custody options to relieve capacity issues in the El Paso, Texas, sector, such as working with nongovernmental organizations or local partners for temporary housing.
• Third, CBP is considering options for medical assistance with other governmental partners, the agency said. That could include support from the Coast Guard as well as possibly more aid from the Defense Department, the Federal Emergency Management Agency, Health and Human Services, and the Centers for Disease Control and Prevention.
• Finally, CBP is reviewing its policies, with a focus on the care and custody of children under 10 — both at intake and beyond 24 hours in custody, the agency said.

These are all good options for dealing with the unknowns of child custody. It’s not clear that any of these would have necessarily helped Gomez Alonso. According to the timeline released by USCBP yesterday, both the boy and his father received water, hot food, snacks, and dozens of welfare checks between the date of his detention (December 18) and when USCBP first noticed symptoms of illness (December 24th, 9 am).

Within 15 hours, Gomez Alonso would be dead, but it wasn’t for lack of initial attention. A processing agent ordered him taken to the ER as a possible flu case, and the hospital tested him for strep before deciding that Gomez Alonso had a cold and gave him Tylenol. However, they later discovered he had a 103-degree fever and kept him under observation for 90 minutes before releasing him back to a temporary holding facility. By 7 pm, the boy was vomiting, but it took until 10 before they took him back to the ER — and he lost consciousness on the way, dying shortly afterward at the hospital.

With the exception of the three-hour delay in getting the boy to the hospital that evening — which has not yet been explained — the USCBP appeared to have gone far beyond the “secondary medical check” that will now be SOP. They flagged the problem at multiple points after proving food and water to both the boy and his father. As the NYT notes, “there is no evidence so far that conditions in detention were the cause” of the death. It makes more sense to look at the hospital, which had him in their care nine hours before his death. Why didn’t they hold him for more observation, especially with a fever of 103, rather than release him to go back to a detention facility? Was that a USCBP decision, or a failure of the hospital? Or a mixture of both?

McAleenan appeared on CBS This Morning today to discuss the tragic death of Gomez Alonso and to defend his agency’s handling of the case. The bigger problem, McAleenan argues, is that the infrastructure of border security was designed and built decades ago when the overwhelming majority of violations were by single young men. Now that entire families and sometimes unaccompanied children make up a much larger part of that population, McAleenan wants Congress to provide the resources and facilities to provide appropriate care and shelter — and that means addressing “border security investments … across the cycle”:

“Is the shutdown worth it?” one of the hosts ask. Remember that the boy’s father was arrested on this side of the border rather than apply for asylum at a checkpoint, which is why the two of them were being detained by USCBP. If the wall was in place, would that have discouraged the border crossing and incentivized the somewhat-safer legal option of applying for asylum at the checkpoint, where resources could be better organized? Some may argue that point, but I’d bet that McAleenan wouldn’t — which is why he’s calling for “investments across the cycle.”

The wall aside, though, McAleenan’s correct that the USCBP needs to revamp its facilities to deal with the immigration issues of today rather than the 1970s. Congress and the Trump administration need to act to ensure that we keep any more children from dying in US custody to the extent that those deaths are preventable. The USCBP may have done all they could for Felipe Gomez Alonso, but we need to make sure of that, and make sure they have enough resources to ensure that in the future.

Update: The Department of Homeland Security wonders if one or more shelters in Mexico might be inadvertently incubating … something:

Officials from DHS said Wednesday they’re investigating the Christmas Eve death of an 8-year-old Guatemalan boy in the custody of U.S. border patrol agents — but they suggested the problem could have originated before he got to the U.S.

There are “literally dozens” of migrants crossing the border each day with illnesses, and DHS is looking into whether migrant shelters in Mexico “may be prone to spreading disease, et cetera, that are causing some of these illnesses,” a DHS official told reporters on a conference call Wednesday.

DHS is seeking to examine health conditions at Mexican migrant facilities, the official said, speaking on the condition of anonymity. Homeland Security Secretary Kirstjen Nielsen will soon be visiting installations south of the border.

It would have to be a bug that takes a week or so to incubate. Gomez Alonso had been in USCBP custody for six days when he got sick.