HOUSTON - A 16-year-old from Guatemala died of complications of the flu while in U.S. Border Patrol custody, according to preliminary autopsy findings, alarming doctors who questioned whether immigration authorities missed warning signs or chances to save his life.
Carlos Hernandez Vasquez contracted bacterial infections in addition to the flu, as well as sepsis, which can lead to tissue damage and organ failure, according to a report released by Hidalgo County authorities this week. He died May 20. A full autopsy is pending.
Carlos is the sixth child in the last year to die after U.S. border agents detained him, and the second known to have died of the flu, after 8-year-old Felipe Gomez Alonzo died on Christmas Eve.
As border crossings surge to historic highs, the Trump administration's treatment of migrant children and the detention of families in overcrowded facilities has come under harsh criticism. The administration is asking Congress for $4.5 billion to respond to the surge of families, but Congress has yet to act.
Flu deaths among children are rare in the U.S. The number of annual flu-related deaths in kids has bounced from 37 to 186 since the 2004-2005 flu season, according to the Centers for Disease Control and Prevention. Doctors usually expect the youngest children, not teenagers, to be more at risk of severe complications and death from flu.
"Flu is uncommon at this time of the year," said Dr. Dawn Nolt, an infectious diseases expert at Doernbecher Children's Hospital in Portland, Oregon. "That someone died of flu is certainly something to be very worried about."
Two doctors said they were alarmed by what's known about the Border Patrol's response to Carlos' illness.
Carlos was detained for six days at the Border Patrol's South Texas processing center, a converted warehouse where 1,500 or more migrants are often kept in large cages formed by chain-link fencing.
The Border Patrol says Carlos reported on May 19 that he was not feeling well and was diagnosed with the flu by a nurse practitioner. He was prescribed the medicine Tamiflu, then transferred to the Border Patrol station at Weslaco, Texas, to prevent his flu from spreading to other detainees.
He was not hospitalized. The next day, he was found unresponsive in his cell.
"By the time you're 16 years old, you have great immunity, and you shouldn't be dying so quickly," said Dr. Nizam Peerwani, the Tarrant County medical examiner in Fort Worth, Texas, and an adviser for the advocacy group Physicians for Human Rights.
Peerwani said Carlos' rapid deterioration raised questions about whether he may have had potential symptoms including a fever, body aches, or breathing trouble before the Border Patrol says he reported being sick.
He should have been taken to a medical facility or clinic instead of remaining in detention, Peerwani said.
Dr. Julie Linton, co-chair of the American Academy of Pediatrics' immigrant health special interest group, also said the prescription of Tamiflu may not have been enough treatment, especially since the medicine works best in the first two to three days of illness. While Carlos' illness was discovered the day before his death, he may have sick well before then, she said.
"We cannot treat Tamiflu as a substitute for the other care that is required," Linton said.
Doctors who treat the flu rely on a patient telling them how long they've had symptoms. Linton pointed out that the processing center where Carlos was detained has the lights on 24 hours a day, which may have made it difficult for him to know how long he had been sick.
After Carlos' death, the Border Patrol found that 32 migrants tested positive for the flu at the same processing center. The agency said it quarantined the sick people and briefly stopped intake at the processing center so cleaning crews could sanitize it.
U.S. Customs and Border Protection, the Border Patrol's parent agency, declined to respond to questions about what measures it was taking to protect detained migrants from the flu.
Both Carlos and Felipe, the 8-year-old who died on Christmas Eve, were detained by the Border Patrol longer than the three days normally allowed by U.S. law and CBP guidelines. Felipe was initially hospitalized but released and returned to a Border Patrol highway checkpoint with his father until he fell sick again.
After the December deaths of Felipe and 7-year-old Jakelin Caal Maquin, CBP ordered medical assessments of all minors in Border Patrol custody, as part of a directive to "enhance the protection of individuals in its custody."
In Carlos' case, the Border Patrol has said it had requested he be placed in a long-term detention facility for children. But children are routinely held by Border Patrol for longer than three days because the long-term facilities for children are themselves at or above capacity.