A May 2018 internal review by ICE, published this week by Rocky Mountain PBS, offers a scathing account of the various missteps committed by staff at the immigration detention facility in the two weeks leading up to Samimi's death. Along with failing to comply with ICE medical standards in a dozen instances, facility staff watched, but failed to effectively intervene, as Samimi deteriorated from opioid withdrawal.
"We have long been aware and [are] suspicious of severe deficiencies in medical care at this facility. This report brings some of our worst fears to light," says Arash Jahanian of the ACLU of Colorado, which is suing ICE over documents related to Samimi's time at the center.
An Iranian national, Samimi came to the U.S. on a student visa in 1976. He eventually married an American citizen and became a lawful permanent resident. Samimi applied for citizenship in 1985 but was denied because he hadn't provided the proper documentation.
Samimi struggled with substance addiction for most of his life. His grandfather had given him opium for an earache when he was four, and he began using the drug recreationally at fourteen, according to the ICE report.
In 1991, Samimi switched to methadone and had been using it daily since. In June 2005, he pleaded guilty to a cocaine possession charge and received a deferred two-year sentence and 64 days of public service.
On November 17, 2017, ICE agents arrested Samimi at his residence in Denver, serving him with a deportation notice based on his felony drug possession conviction. Samimi was then taken to the detention facility in Aurora, which is run by private prison company GEO Group through a contract with ICE. The facility, which is also staffed by GEO, houses immigrant detainees in ICE's custody.
During his initial intake, Samimi told medical staff at the facility that he takes 190 milligrams of methadone per day. But they decided to cut him off entirely.
"When you cut someone off cold turkey, that's just like slapping them in the face," says Kimberly Sue, medical director at the national Harm Reduction Coalition and a physician at the Rikers Island prison complex.
From the beginning of his stay in the Aurora detention facility, the 64-year-old exhibited symptoms of opioid withdrawal, which medical staff noticed early on. But instead of employing the commonly used Clinical Opiate Withdrawal Scale to assess Samimi's symptoms, they instead used an alcohol-withdrawal assessment and treatment sheet.
The ICE report notes that a nurse "stated that she knows that alcohol and opioid withdrawal are clinically different and that she inadvertently used the wrong form."
GEO Group declined to answer specific questions about the case but sent us this statement: “Individuals who are assigned by ICE to be housed at the Aurora ICE Processing Center are medically screened immediately upon arrival and receive a full physical within 14 days of their admission. Further, the facility provides around-the-clock medical care. GEO’s medical program at the facility provides 24/7 medical services; is supported by a team of medical professionals that includes a full-time physician, a full-time physician’s assistant, a cadre of nursing services, dentist, psychologist, psychiatrist as well as referrals to local community hospitals as needed; and is fully accredited by the American Correctional Association and the National Commission on Correctional Healthcare.”
In the first recording of Samimi's withdrawal, a nurse gave him a score of seven, "indicating the level of alcohol withdrawal did not require medication treatment," according to the report. The threshold that indicates severe alcohol withdrawal is fifteen.
"It seems to me pretty clear that they had no idea what to do with someone with methadone dependency," says Liz Jordan, an attorney who advocates on behalf of detainees through the Civil Rights Education and Enforcement Center.
The nurses told ICE investigators that they were never trained in opioid withdrawal, and their "actions demonstrated a lack of understanding of opioid withdrawal symptoms," according to the report.
Samimi's health continued to deteriorate. Seemingly less serious symptoms, such as anxiety, gave way to severe stomach pain and loss of consciousness. But not everyone took Samimi's symptoms seriously.
The facility's lone full-time physician, who was supposed to oversee Samimi's medical care but never examined him, thought he was faking symptoms "to get what he wanted" — i.e., methadone. Other medical staffers shared that sentiment. "The majority of nurses interviewed stated they believed Samimi was malingering and seeking drugs throughout his stay and did not see an urgent need to notify the physician of his worsening condition," the report notes.
Some security officers recognized that Samimi was withering away. "All officers interviewed observed significant deterioration in Samimi's condition, especially during the 48 hours prior to his death," the report states. "All officers were troubled by what they perceived was a lack of concern and care for Samimi," and multiple officers "did not share the opinion voiced to them by nurses that Samimi was faking his symptoms."
On November 26, a little over a week after he had been detained, a nurse gave Samimi a nineteen on the alcohol withdrawal scale but did not notify the facility's physician. Later that night, Samimi slid from his wheelchair onto the floor.
Two days later, after he collapsed in a hallway, a nurse reported that "no matter his actions, stronger meds unavailable." That same day, Samimi attempted to hang himself with his bedsheets.
"Especially in sites of closed custody such as jails and prisons, suicidal ideation and suicide attempts in the setting of inadequately treated opioid withdrawal is not uncommon," Sue says.
Samimi was placed on suicide watch and saw a psychiatrist, who recommended that medical staff monitor him for ten days using the opiate withdrawal scale. But staffers again failed to utilize the system.
On December 1, at 3:30 a.m., staffers observed Samimi talking to himself, attempting to drink from a toilet, falling and rolling on the ground. Later that morning, Samimi fell out of his wheelchair and "did not attempt to break his fall," according to the report.
A security officer notified a nurse, who said the staff doctor was aware. The facility did not call 911.
The security supervisor told ICE investigators "that in retrospect, he wished he had called 911 himself but did not because he was told Dr. [redacted] was fully informed. He commented he has 'had battles with Dr. [redacted] in the past' and has lost; consequently, he knows his 'boundaries.'"
The facility's medical staff had only been administering half the medication that doctors had prescribed Samimi and had only taken his vital signs every twelve hours as opposed to the recommended eight. Despite his odd behavior, Samimi's vital signs were normal throughout his detention, according to medical records.
On the night of December 1, "Samimi screamed for nurses and complained of abdominal pain," and staffers observed that he was spitting up blood. A nurse didn't check on him until 75 minutes later.
Over the course of the night, Samimi continued to complain of abdominal pain, was vomiting and said he couldn't breathe. The symptoms continued through the morning of December 2.
A security officer reported Samimi's condition to nursing staff but was ignored.
"They displayed a real skepticism towards him and what he was telling them," Jordan says. "We see that quite a bit in lots of different facilities. Staff are constantly accusing people of faking it and show very little empathy and very little understanding."
Around 11 a.m., after Samimi fell out of his wheelchair and vomited blood, the on-call nurse did not immediately call 911 because "he did not deem the situation an emergency." Instead, he called the staff doctor, who works forty hours a week but is required to be on call 24/7. The nurse left messages at the doctor's house and on cell phones, which the physician later said he didn't receive.
Finally, at the suggestion of one of the security guards, the facility called 911. EMTs arrived and found Samimi unresponsive and without a pulse. He was transported to a nearby emergency room and was administered CPR and a defribillator, to no avail.
Emergency-room personnel noted black vomit on Samimi's face and in his airway, which might have been a sign of gastrointestinal bleeding.
An autopsy failed to determine Samimi's exact cause of death, but it did note emphysema and gastrointestinal bleeding as contributing factors. The coroner also wrote that he "could not rule out methadone withdrawal as the cause of death, but noted that deaths due to methadone withdrawal are rare."
The detention facility conducted two reviews of the death, finding that staffers had adequately handled Samimi. "The resulting report stated that both medical and security staff acted properly and in accordance with policy and procedures on December 2, 2017," the ICE investigation noted of the facility reports.
One of the reviews determined that all nursing staff should use their "clinical judgement and call 911 when presented with a life or death situation."
The review also states that Samimi "appeared to progress well with withdrawal protocol, [and] began demanding 'stronger medications.'" But the ICE investigation disagreed, noting that "the basis for the statement that he appeared to progress well is not supported by the medical record. Although not clearly addressed in the medical record, security and video documentation suggest Samimi's withdrawal symptoms progressively worsened."
Neither of the facility's investigations utilized video footage to analyze what actually happened or whether protocol was followed. "As a result, conclusions reached during both reviews were based, in part, on incomplete information," the ICE report says.
The staff doctor told investigators that he had considered giving Samimi methadone, "but dismissed the idea of a methadone detoxification regimen because of the dose Samimi reported taking and because he was unable to verify the detainee was getting it legitimately."
Jordan has reviewed over two dozen of these types of investigatory reports and says she has never seen such a prolonged demise. "It was over two weeks, not a couple of hours. This was someone who was having a slow-rolling medical emergency, and they had no idea how to deal with it."
Jordan isn't optimistic that ICE or GEO Group will change any policies following Samimi's death. "Unfortunately, this is not the first death in ICE custody, and it won’t be the last. So far, we’ve seen no steps taken to make changes. I can’t think of any death review that resulted in a bunch of changes."
An ICE statement to Westword reads: "As a matter of policy, U.S. Immigration and Customs Enforcement does not comment on pending litigation. However, lack of comment should not be construed as agreement with or stipulation to any of the allegations. As part of the Department of Homeland Security’s homeland security mission, our trained law enforcement professionals adhere to the Department’s mission and values, and uphold our laws while continuing to provide the nation with safety and security."
Jahanian of the ACLU of Colorado is continuing his litigation and is still trying to access documents related to Samimi's death from ICE. "The report was done a year ago. It's mind-boggling that they took this long to release it."