ICE Inspectors Found CoreCivic Violated Suicide Prevention Standards at Stewart. Less Three Months Later, An Immigrant Ended His Life There

ICE's Office of Detention Oversight Again Failed to Hold CoreCivic and the Atlanta Field Office Responsible for Detention Standards Violations. Did it Enable the Latest In-Custody Death?

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In today’s post, I’ll explain why ICE’s inexplicable failure to impose binding, corrective action on CoreCivic after finding its suicide prevention practices at Stewart Detention Center violated ICE standards during the most recent inspection may have contributed to the most recent death in ICE custody there.

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“The system is so loaded with people, exacerbating bad conditions – it’s like a ticking time bomb.”

Amilcar Valencia, El Refugio, June 22, 2025, The Guardian

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“Staff describe Georgia immigrant detention center as ‘ticking bomb’”

Elly Yu, WABE News June 5, 2028, Reveal

“Acceptable/Adequate”

ICE’s Office of Detention Oversight (ODO) inspected Stewart on March 18, 2025. The inspection found 12 total deficiencies in 8 standards categories out of 28 reviewed.

For those keeping track at home, that’s a 71.4% grade, which ODO concluded was “Acceptable/Adequate.” The ‘gentleman’s D+’, if you will.

Inspections are supposed to lead to compliance. They’re called the “performance-based” national detention standards. Performance at a D- level is acceptable/adequate, in ICE’s eyes, apparently. In August 2024, ODO also found 12 deficiencies. Unlike the last inspection. which resulted in three corrective actions, ICE imposed no corrective actions CoreCivic following the inspection this past March. Instead, ICE simply put ERO Atlanta on the honor system:

“ODO recommends ERO Atlanta work with the facility to resolve any deficiencies in accordance with contractual obligations.”

March 2025 ICE ODO Inspection

Except it’s not just ODO that is supposed to handle these obligations. It’s the ICE Contracting Officer and ICE’s Office of Acquisition Management (OAQ) that should be levying penalties. This was the conclusion of the Government Accountability Office (GAO) in its early 2021 report titled, “Actions Needed to Improve Planning, Documentation, and Oversight of Detention Facility Contracts.”

It’s not just the Contracting Officer’s representative, who’s under the instruction of the Field Office (ERO ATL), but also the Contracting Officer, who is responsible for assessing penalties and ensuring compliance, says GAO. ODO’s reliance on ERO ATL to compel compliance without filling out a Uniform Corrective Action Plan (UCAP), then, is telling.

ERO ATL had to stop imprisoning alleged non-citizens in the Cobb County jail in Marietta, Georgia because of a Congressional mandate that facilities failing two consecutive inspections may not receive federal funds to detain immigrants.

Here’s DHS’s recognition of this legal requirement:

Here’s Cobb County’s result for 2023:

And 2024:

Because ATL ERO wasn’t able to help bring Cobb into standards compliance, ICE lost its legal ability to detain people there.

Corrective Actions: 0

So, what’s a “failing” inspection? According to ICE ODO, a “Fail” rating is any inspection that comes in lower than 70%:

Okay, so, with 71.4%, Stewart came in just above the “Failure” rating. This would have put one of CoreCivic’s largest ICE detention centers, and the source of at least $40M in guaranteed annual revenue from ICE, at risk of closure in the event of a second consecutive failed inspection. Big implications for big-dollar donors, and even bigger implications for ICE ERO ATL’s bed capacity.

But there’s another problem with the inspection: Despite finding two priority components noncompliant, ODO imposed 0 Corrective Actions on Stewart. This meant there would be no contractual penalties or consequences for fixing what the Detention Oversight inspectors said was broken.

So, what was that, exactly?

“Priority” in Name Only

ODO found CoreCivic had failed to train all security and medical staff on Significant Self-Harm and Suicide Prevention, based on a review of training records. It also found that 1 in 5 (20%) of the people on suicide precautions at Stewart were not monitored in accordance with the staggered period of every 15 minutes or less which, experts say, is critical to preventing death by self-harm. In at least one instance, CoreCivic personnel failed to log a visual inspection on a person under suicide precautions for more than two hours.

ICE ODO found these violations both involved “Priority Components”.

It could very easily have noted additional violations implied by these two. Like the violation of the requirement to provide 24/7 care and security for detained people. But if ODO had found CoreCivic violated this PBNDS standard, it would have added a 9th category of non-compliance, and that would have led to a failing inspection. So the inspectors just let it go, and encouraged ERO ATL to work with CoreCivic to self-correct.

On June 7, 2025, a man died by suicide at Stewart. We don’t have many answers to how that happened at this point, because ICE hasn’t bothered to provide them. Was he on suicide watch? Had he previously attempted to end his life, or expressed his desire to do so to facility staff, as happened with Jean Jimenez and Efrain Romero? Was he in solitary confinement or otherwise locked inside a cell by himself?

911 records show people locked inside Stewart attempted suicide on at least 3, and possibly 4, occasions in the past two years:

Fortunately, none of those folks passed away. But you can only be so lucky for so long, which is why the trainings, standards, policies, and inspections are in place. When you ignore them, and treat them as though they’re optional 20% of the time, eventually, your luck runs out. And if the June 7 death at Stewart was indeed, the 4th suicide attempt in just over 2 years, then the odds were increasingly not in the facility’s favor.

Again, I will share the expert reports from the Romero wrongful death litigation that settled for an undisclosed sum a few years ago. These export reports found CoreCivic and ICE and Stewart failed to comply with suicide prevention policies, contractual obligations, and best practices, and that those failures likely contributed to Efrain’s death. I wonder what the experts will find when they finally get the records about the latest failure of CoreCivic, the Atlanta Field Office, and ICE’s inspection regime at Stewart.

Because the government ceased publishing these findings back in 2017, it will take FOIA requests and lawsuits to get them promptly. If you’d like to help fuel that work, please consider becoming a paid subscriber.