I

nside his cell in the Yuba County Jail, Rafael was vomiting again, too weak and dizzy to stand. He is HIV-positive and has hepatitis C. Without treatment, the two can be a deadly combination. But Rafael, 27, had not been treated for hepatitis C in six months, his medical records show.

KQED agreed not to use Rafael’s real name, to protect his medical privacy. More than once, Rafael says, he has been the target of violence as a result of the stigma of his illness.

By March, Rafael had been held in the jail for half a year, waiting to find out if he would be deported to Mexico, the country of his birth. He tried to tune out the arguments of the other inmates over what to watch on television -- a struggle between criminal defendants and immigration detainees, orange uniforms versus red ones. He tried to ignore the flooded bathroom sinks. He tried to ignore the nausea. More than anything else, he thought about seeing a regular doctor rather than the jail's medical staff, who seemed to dismiss his worsening condition.

Rafael is one of roughly 200 men and women held by Immigration and Customs Enforcement at the Yuba jail on any given day. They make up about half of the jail population here in this rural county in the Sacramento Valley.

As the Trump administration moves to vastly expand the deportation of immigrants, county jails across the country could be increasingly put to use to detain them because ICE facilities have simply run out of room. But ICE itself has repeatedly faulted Yuba County -- and other jails where immigrant detainees are held -- for inadequate conditions that fail to meet ICE's own standards. Yuba also faces a lawsuit over what inmate advocates call “negligent” care.

The concern over a lack of safe and humane conditions at Yuba, and across ICE's already strained detention system, is propelling some California lawmakers to try to disentangle the state from Trump's deportation push.

Three bills moving through the California Legislature could alter -- or end -- the ability of cities and counties to enter into detention contracts with ICE. But Yuba officials say that could spell disaster for their county’s finances.

Expanding Detention and Deportation

Yuba County is among about 200 U.S. cities and counties that hold ICE detainees in local jails and private prisons under multimillion-dollar contracts with the federal government. Nationally, an average of 37,706 people a day are locked up, facing deportation. That’s 17 percent more than in fiscal year 2016, according to ICE data.

The Yuba jail began detaining immigrants for the federal government in 1994. These days, the arrangement generates close to $6 million a year. That money supports half of the sheriff’s operations, according to a recent county budget proposal.

“You come to rely upon that,” said county spokesman Russ Brown. “We make no bones about that. We've been able to find some level of stability.”

Brown said Yuba County and other local governments that have held ICE contracts for decades are now caught in a political crossfire.

“Yuba County is conducting a service and (we) have been for years, and then because of a political battle Yuba County could very well see public safety fall off the map," Brown said.

Fleeing the Stigma of HIV

Rafael was 6 months old when he came with his parents to the Bay Area from Mexico. He went to school in San Francisco and all of his family lives here, he says. As a kid he’d rent out local driveways and parking lots for 49ers football games. He punctuates every few words with “like” or “you know.” It wasn’t until he was in high school that he discovered he didn’t have legal status in the United States. That’s when his parents took him to meet an immigration lawyer after he was a victim of a crime.*

But before getting protection, he was arrested for drug possession and deported in 2010. In Mexico he discovered he was HIV-positive. That began a cycle of re-entries and deportations.

Rafael said he was physically threatened while seeking treatment for HIV in Mexico. He and his lawyers say he suffered even more traumatic incidents there. KQED agreed not to disclose them because he hasn’t shared what happened with his family. But he said he feared for his life, and fled back to the United States.

By 2016, Rafael had been diagnosed with hepatitis C, depression and post-traumatic stress disorder, along with HIV.

Last September, he was convicted of driving under the influence and served 42 days at an Alameda County jail. As he was being released, Rafael was apprehended in the jail lobby by two immigration officers who sent him to ICE detention near Sacramento, ICE records show.

This time, Rafael tried to get an attorney to fight his deportation. He composed letters to lawyers outlining his fears and his medical conditions. He hid them under his mattress, the only private place he could find. One day, he returned from court to the cell he shared with several other men and saw his private papers out in the open, spread on top of his bed.

“Usually everybody came in and greeted me, just said, ‘How’s it going?’ But that day everybody was just looking at me,” Rafael said. He described the incident later in a phone call from jail, speaking softly so other inmates wouldn’t overhear.

As the confrontation unfolded, Rafael said, a friend warned him that his cellmates had read his letters and were threatening to harm him if he didn’t leave the jail.

“Everybody thought that they were going to get my infections, through me sitting down on the toilet and stuff like that,” Rafael said. “So everybody just decided that I had to go.”

Rafael grabbed his belongings and rushed to the common area, where he pressed an emergency button to summon the guards.

For his safety, ICE transferred Rafael from Sacramento to the Yuba County Jail in Marysville on Oct. 27.

Waiting for Treatment

When ICE moves a detainee, the agency is supposed to transfer all of the person’s medical records. But documents show that Yuba County Jail staff didn’t know at first that Rafael had hepatitis C. Even after they had confirmed his diagnosis, they still did not treat him.

“They weren't trying to give me my medicine, and I had symptoms,” he said in an interview from the jail. “I always put (in) my request to see the doctors and all they do is just give me, like, just Tums,” he said.

Kelly Wells, an immigration attorney with Dolores Street Community Services, took on Rafael’s deportation case. But she said she ended up spending a lot of her time pushing jail officials to provide proper medical care.

“Hep C, HIV co-infection can proceed within a matter of months to liver failure and death. So obviously we had a lot of concerns. He was exhibiting symptoms at the time, too -- symptoms that we don’t know what they were, as lawyers,”  Wells says. “What we know is, he needs to see a real doctor who knows hep C.”

Both Rafael and his attorneys, Wells and Frances Kreimer,  submitted requests for him to see a specialist as he became more ill.

“They don't treat you like a human being (in jail),” Rafael said. “It’s really different outside. My doctors would stay and explain to me, you know, details and stuff like that. They would do blood work and they would do all kinds of stuff to make sure that I didn't have anything else, you know, [a] complication. But in here, they don't do none of that. I have to ask for, like, blood work. My lawyers have to call them.”

KQED requested an interview with Yuba County’s sheriff (and a tour inside the jail) many times over the course of five months. Sheriff Steven L. Durfor declined to speak with us, citing many reasons, including the lawsuit challenging jail conditions.

However in court documents, the Yuba County counsel wrote that jail guards and medical staff are appropriately trained, have passed inspections and successfully “balance the legitimate interests of the jail with the rights of inmates.”

How Yuba County Got Entwined With ICE

It’s not as if Yuba County set out to become so reliant on immigration detention.

County spokesman Russ Brown, who also handles legislative affairs, said the county’s financial dependence on ICE has grown over the years, largely due to elemental forces that eroded the local economy.

Most people in Yuba County live and work near the confluence of the Feather and Yuba rivers -- an area prone to flooding.

Brown said a catastrophic flood in 1986 started a downward spiral.

That February, following a series of severe winter storms, a levee on the Yuba River collapsed, opening a 30-foot-wide gap that allowed water to engulf the towns of Linda and Olivehurst.

Aerial photographs of the flood show whole neighborhoods submerged in water, with only the rooftops of houses showing.

The flooding covered more than 30 square miles, killing one person, destroying nearly 900 homes and causing $95 million in damage, according to the Yuba County Office of Emergency Services.

“It was one of those events,” Brown said. “It changes the status of a community overnight.”

The flood also destroyed a vital economic driver for the county: the Peach Tree Mall in Linda.

Mary Jane Griego, a former Yuba County supervisor who owns and runs the popular Duke’s Diner in Olivehurst, remembers she was driving right by the mall that evening in 1986 when a sheriff’s deputy stopped her.

“There was a deputy that skidded into the intersection,” Griego recalled, “And he said, ‘Lady, the levee broke and here comes the water!’ And I looked over there and this wall of water is coming right towards the mall and towards us.”

She tore off in her car and drove to higher ground.

The water rose to nearly the top of the mall, forcing people inside to escape to the roof, to be airlifted to safety.

ICE Contract Helps Yuba County Weather Economic Downturns

Griego sees the destruction of the mall as an economic blow from which Yuba County has yet to recover, even three decades later.

When the Peach Tree Mall opened in the 1970s it held a movie theater, an arcade, and plenty of shops and eateries.

“That’s where all the kids hung out.” Griego recalled, “Either you were working there at the Orange Julius, meeting your friends there, or stopping by J.C. Penney’s to pick up some clothes for school. It was the place to be at!”

Today the Peach Tree Mall sits with boarded-up windows and doors chained shut. It’s too far gone to renovate, and too expensive to remove.

“It’s depressing to look at,” Griego said. “All 57 businesses left and not one of them came back.”

Most of those businesses relocated to a mall just across the Feather River in neighboring Sutter County, and most Yuba residents now cross the bridge to shop there.

Watching that sales tax revenue pour into another county, Griego said, makes her “resentful, mad, angry.”

Another catastrophic flood in 1997 caused an additional $300 million in economic losses.

Griego was first elected to the Board of Supervisors in 2000. She said the economy was in bad shape, forcing county officials to cut back vital services for residents.

“We cut a lot,” Griego recalled. “I mean we cut to the bone, and then we cut to the bone marrow after that. And then there was nothing left to cut.”

The hardship for Yuba residents would have been even worse, she said, had it not been for the revenue from the contract to detain immigrants for ICE.

In 2008, the Board of Supervisors approved an expansion of the contract to lease up to 220 jail beds -- more than half of the entire jail -- to ICE.

Yuba County's History of Immigration

Ongoing Allegations Over Negligent Medical Care

While the contract has helped the county, inmates and their advocates say the funds from the ICE contract haven't led to improved jail conditions -- for immigration detainees or the rest of the jail population.

Grand juries, human rights advocates and lawyers for inmates -- along with ICE auditors and county officials -- all have documented problems, ranging from inadequate medical and mental health care to overcrowding.

The Yuba County Jail can hold up to 433 inmates, and it’s usually close to full, ICE audits and state data show. The jail shares a cramped building, originally built in 1962, with the courthouse, county records and part of the sheriff’s department.

KQED was not permitted inside the jail, but a view of the conditions can be gained from government records and photographs taken by lawyers. The cells have bars with flaking paint. The jail’s medical facilities are underground. A May 2015 grand jury report noted that staff call part of the facility the “dungeon.” But the grand jury was more concerned with the lengthy delays for some inmates to see a doctor, or even a nurse.

The Yuba County Jail’s medical staff struggles to function in a small space, county officials wrote in a grant application to the state. Staff members use a single room for medical exams, psychiatry appointments and as an office.

Rafael described the lack of privacy. “They take you in with a bunch of inmates, and other inmates are waiting for their appointment,” he said. “Everybody can hear clearly what you're talking about.”

Rafael said he wrote notes to the doctor as a way to explain his concerns privately. But then the doctor read the notes aloud.

“I’m still scared, you know,” he said. “I don’t like people finding out my medical situation.”

ICE’s medical policy specifically requires facilities to ensure patient confidentiality, especially for people with HIV. In several reports ICE criticized the Yuba jail’s policy of allowing jail guards to read inmates’ medical requests.

Some inmates say they’ve suffered much more egregious problems with guards at the Yuba County Jail. Orsay Alegria-Simuta told KQED that he was beaten by a jail guard earlier this year while having an epileptic seizure. He said the staff denied him his prescribed medication and placed him in isolation for three days.

“I am not a criminal,” said Alegria-Simuta, who was held by ICE for months while in deportation proceedings. “I simply wanted my pills that day.”

Alegria-Simuta, a native of Mexico*, is no longer locked up. But he said his right hand remains damaged from the beating. ICE is investigating the incident. The jail guard resigned.

ICE officials say Yuba County does a poor job of monitoring its own jail. In recent audits ICE found that the facility did not properly investigate sexual assaults or guards’ use of force. Jail officials did not medically screen inmates after such incidents, and failed to inform ICE about what occurred, the audits found. County officials did not respond in writing to ICE audits.

Attorneys Sue Over Jail Conditions

Conditions at the jail have been notorious for so long that the county has been under court order to improve them for 38 years. Attorney Jennifer Stark, who helped with a lawsuit to enforce the order, has toured the jail several times and has spoken with immigrant detainees and other inmates.

Stark described an October 2014 incident in which a man attempted to hang himself in the shower, using a sheet. Other inmates found the man, but because there was no emergency call button they had to scream for several minutes to get the guards’ attention, she said. When the guards arrived, they weren’t carrying the proper masks to conduct CPR, so it was the inmates who worked to revive the man.

“The jail knew about this problem and did nothing,” said Stark. “No emergency call buttons were put into the old jail. … A few months later the very person who had been attempting CPR on his friend attempted to hang himself in the H-tank shower in the exact same way.”

In court documents, the Yuba County counsel called the concerns about suicide “exaggerated and misconceived.” The county noted that no inmates have died of suicide in the last 10 years and that “acts of self-harm do not equate a suicide attempt.” Court documents also show that, starting in March 2015, the jail added 16 emergency buttons and 13 security cameras, and is in the process of eliminating pipes that inmates could use to hang themselves.

However, a recent grand jury was worried that inmates were unable to access psychiatric help, and when they did it was mainly through videoconferencing. When inmates told staff that they were having a mental health crisis, they were sometimes placed in isolation for days at a time, the grand jury and ICE found.

Rafael’s lawyer, Kelly Wells, told KQED that she had been representing Rafael for several months before he admitted he was having suicidal thoughts at Yuba.

“He told me that he hadn't revealed them to ICE specifically because he was afraid that he would be put into some kind of worse conditions,” Wells said.

A $20 million grant from the state will help pay for a new medical wing, scheduled to open in 2020, with more space for confidential treatment. In the meantime, jail officials have increased group therapy with a crisis counselor.

The most recent grand jury also noted that despite problems, “overall, the Jail runs very effectively given their limited budget.“

In an application for the grant to build the new medical and mental health wing for the jail, county officials wrote that “the existing mental health and medical treatment, dental treatment, medical holding, medical and mental health beds, inmate programs, staff support, and laundry spaces are all deficient or non-existent in this facility.”

Conditions of Detention Spur State Response

Ongoing reports of inadequate care for immigrant detainees in California jails and private prisons prompted several state lawmakers to try to overhaul the state’s role in ICE detention.

President Trump’s promise to deport millions more undocumented people added to the urgency.

Senate President Pro Tem Kevin de León (D-Los Angeles) introduced a bill this year that would prohibit local agencies from using resources “to investigate, interrogate, detain, detect, or arrest” people for immigration purposes.

“It begs some ethical questions: whether counties should be profiteering on a very polarizing and polemic issue, which is the issue of immigration,” de León says.

While SB 54 does not explicitly target the ICE contracts of a dozen California cities and counties, including Yuba County, a legislative staff analysis observes “prohibitions in the bill would make local law enforcement agencies legally unable to continue to carry out such a contract.”

Two other measures could also impact local jails.

SB 29, introduced by state Sen. Ricardo Lara (D-Los Angeles), would require local jails with ICE detainees to provide a higher standard of care and subject them to a new layer of scrutiny. The attorney general would also be able to sue counties and cities and private prisons for any gross violations.

SB 630, introduced by state Sen. Nancy Skinner (D-Berkeley), would withhold state funds for jail construction from counties, including Yuba, Orange and Contra Costa, that hold people for ICE.

All three bills have passed the state Senate. The Assembly will vote on them later this summer. If they pass it’s unclear whether Gov. Jerry Brown will sign them.

Yuba Braces for Loss of Funds

Sacramento’s legislative backlash against the Trump administration’s immigration agenda frustrates officials in Yuba County. They say struggling local governments, not the state, will pay for it.

County spokesman Brown said federal funds for detaining immigrants are now so closely intertwined with the general budget that any loss could force the county to shut down vital services.

“It will decimate the budget of this sheriff's department, it will cause severe problems in terms of how they're able to serve our residents,” Brown said.

The sheriff could be forced to cut deputies patrolling the streets -- or find other ways to economize, Brown says.

Ultimately Yuba County leaders fear they might have to shut down the jail.

Rafael Gets His Day in Court

None of these changes will directly impact Rafael. He was released from the Yuba County Jail in April after being locked up for eight months. The medical staff finally began giving him his hepatitis C medication in the last three weeks of his incarceration. At his final immigration hearing, a judge found that Rafael has a legitimate fear of persecution if he were deported to Mexico, and granted him “withholding of removal.” It allows him to stay in the United States legally, but does not provide a path to citizenship.

“I was really relieved for him because honestly, by that point, I had really started to lose faith in the immigration system,” said Rafael’s lawyer, Wells. “I've seen cases drag out and clients remain detained for so long for no reason.”

Just a few months after winning his freedom, Rafael found a new home and a new job in the Bay Area. Wells said Rafael is excited to spend more time with his two young children, who are both U.S. citizens. She’s currently helping him get health insurance so that he can see a doctor.

KQED asked Rafael for an interview after he was freed, but he declined. He said he doesn’t want to relive everything he’s been through.

[yubaDox]

*Note that this piece has been updated to clarify Rafael's first immigration consultation. We have also updated the story to state that Orsay Alegria-Simuta's is from Mexico.