Case 3:16-cv-03539-LB Document 84-3 Filed 10/05/17 Page 2 of 6 From: Sent: To: Subject: Attachments: Wynne, Maggie (HHS/IOS) Saturday, March 04, 2017 1:47 PM Leggitt, Lance (HHS/IOS); Skrzycki, Kristin (HHS/IOS); Stannard, Paula (HHS/IOS); ; Murphy, Ryan (HHS/IOS) Bowman, Matthew (HHS/IOS); Flick, Heather (HHS/IOS); Lloyd, Scott E. (ACF) FW: Heightened Medical Procedures Guidance medical_services_requiring_heightened_orr_involvement.pdf Importance: High Cc: All, Here is a directive that the career Acting Director of the ACF Office of Refugee Resettlement (ORR), Ken Tota, sent last night to all ORR staff. I will also send you in a separate email a similar communication to all ORR grantees caring for unaccompanied alien children (UACs or UCs). the last few days have revealed that ORR-funded grantees have taken action in violation of the attached policy to procure abortions for minors in the ORR Director's care and custody without his authorization. Maggie From: Sent: Friday, March 03, 2017 11:24 PM To: Wynne, Maggie (HHS/105); Barlow, Amanda (ACF); Tota, Kenneth (ACF); White, Jonathan (ACF); Lloyd, Scott E. (ACF) Subject: FW: Heightened Medical Procedures Guidance Importance: High Good evening, For your records, below is the email sent to ORR staff. Kindly, From: ORR Director (ACF) Sent: Friday, March 03, 2017 11:17 PM Subject: Heightened Medical Procedures Guidance Importance: High Dear Colleagues, CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00004528 Case 3:16-cv-03539-LB Document 84-3 Filed 10/05/17 Page 3 of 6 I am writing to reinforce the importance of ORR policies and procedures related to Heightened Medical Procedures, including "significant medical or surgical procedures, abortions, and services that may threaten the life of a UAC." Per the policy, "Grantees are prohibited from taking any actions in these cases without direction and approval from ORR." Approval for such procedures would be provided in the form of a signed authorization from the Director of ORR. To restate and reinforce the existing policy, grantees may not perform Heightened Medical Procedures without written authorization from the ORR Director, except in emergency medical situations (as described in Emergency Medical Services, 3.05). Grantees should not conduct procedures, or take any steps that facilitate future procedures such as scheduling appointments, transportation, or other arrangements without signed written authorization from the ORR Director. Note that the requirement for written authorization by the ORR Director applies whether the procedure will be paid for with Federal funds or by other means. In your role, please ensure close adherence and understanding of the policy. It is important that your discussions or correspondence in no way confer or imply approval. Approval can only be authorized by the ORR Director in writing. The policy on Heightened Medical Procedures is attached. If there are questions or concerns, please do not hesitate to write. Sincerely, Ken Tota Acting Director 2 CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00004529 Case 3:16-cv-03539-LB Document 84-3 Filed 10/05/17 Page 4 of 6 Thanks From: Sent: Wednesday, March 22, 2017 4:47 PM To: Subject: RE: ORR Guidance for Pregnant UC , Hope this email finds you well. I have a follow up question for you. In your email below, you state we cannot take a client to get a judicial bypass on a termination of pregnancy unless the ORR Director approves us to do so first. Isn't that contrary to state law? My understanding is that the judicial bypass was created specifically so that the young lady does not need approval from her guardian (in our case the Director of ORR) to move forward with a term of pregnancy. Has this policy been vetted by your legal department? I anticipate there would be legal challenges to this policy by advocacy groups that have historically represented our minors in these cases. Can you give me any feedback on this issue? Thanks. CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00004530 Case 3:16-cv-03539-LB Document 84-3 Filed 10/05/17 Page 5 of 6 From: Sent: Friday, March 10, 2017 2:38 PM To: Cc: White, Jonathan (ACF) ; Sualog, Jallyn (ACF) ; Tota, Kenneth (ACF) ; De LA Cruz, James (ACF) ; Subject: ORR Guidance for Pregnant UC Importance: High Good afternoon! Effective immediately, ORR is requiring grantees to notify ORR through their assigned Federal Field Staff immediately of any request or interest on any girl's part in terminating her pregnancy. A response from ORR Director would be required before taking any next steps (i.e., scheduling appointments, pursuing a judicial bypass, or any other facilitative step). 2 CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00004531 Case 3:16-cv-03539-LB Document 84-3 Filed 10/05/17 Page 6 of 6 Per the policy, "Grantees are prohibited from taking any actions in these cases without direction and approval from ORR." Approval for such procedures would be provided in the form of a signed authorization from the Director of ORR. To restate and reinforce the existing policy, grantees may not perform Heightened Medical Procedures without written authorization from the ORR Director, except in emergency medical situations (as described in Emergency Medical Services). Grantees should not conduct procedures, or take any steps that facilitate future appointments without signed written authorization from the ORR Director. Note that the requirement for written authorization by the ORR Director applies whether the procedure will be paid for with Federal funds or by other means. Please ensure close adherence and understanding of the policy. Approval for such procedures can only be authorized by the ORR Director in writing. Failure to adhere to this policy will be a significant issue of non-compliance. If there are questions or concerns, please do not hesitate to contact your assigned Federal Field Staff for clarification. Thank you! 3 CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00004532 Case 3:16-cv-03539-LB Document 84-4 Filed 10/05/17 Page 2 of 2 From: White, Jonathan (ACF) Sent: Thursday, March 30, 2017 3:39:33 PM To: Cc: De LA Cruz, James (ACF); Sualog, Jallyn (ACF) Subject: FW: UC requesting pregnancy termination , Please see Scott's email below with regard to the UC at SWK Las Pal mas who is ready for discharge and has previously requested pregnancy termination. ORR previously provided the grantee with specific direction regarding the type of services the UC should be connected with. Please see his direction that the program "should not be supporting abortion services pre or post-release; only pregnancy services and life-affirming options counseling." If we can reinforce this to the provider and ask them to clarify that the discharge plan is consistent with that direction, that will enable us to proceed with next steps for release for the UC. Thanks for all your hard work on this case. Jonathan From: Lloyd, Scott (ACF) Sent: Thursday, March 30, 2017 6:26 PM To: White, Jonathan (ACF) Subject: RE: UC requesting pregnancy termination Jonathan, It's unclear what they mean here. Not sure what they mean by "services" and "abortion counseling." Please ask them to explain clearly, because if I recall, we were very clear about what they were to do. Grantees should not be supporting abortion services pre or post-release; only pregnancy services and life-affirming options counseling. Thank you, Scott , (I am looping in cc'ing Jim for clarity in communications.) Just spoke with Scott. The UC should proceed to discharge; we concur with the program's recommendation that neurology follow-up can be part of the plan for the minor's discharge rather than delaying it. A couple things: • Can we confirm that the minor has received options counseling for the pregnancy as discussed? • Can we confirm that the sponsor and the minor's parents have been notified of the pregnancy? 3 CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00010706 Case 3:16-cv-03539-LB Document 84-5 Filed 10/05/17 Page 2 of 4 From: Lloyd, Scott (ACF) Friday, March 17, 2017 4:43 PM Sent: To: Cc: Subject: White, Jonathan (ACF); De LA Cruz, James (ACF) RE: Quick thoughts Message from Mr. Scott Lloyd This is just a quick note to find out whether there are any updates on placement, as there was an indication at the beginning of the week that we may be close. I am just checking, not looking to rush things. - In related news, I hope you had a good rest of the week. Thank you, Scott From: Sent: Tuesday, March 14, 2017 6:22 PM To: Lloyd, Scott (ACF) Cc: White, Jonathan (ACF); De LA Cruz, James (ACF) Subject: RE: Quick thoughts Message from Mr. Scott Lloyd Sir all requests have been sent to local FFS and providers. i don't foresee any issues with these requests, but I do have a question and a comment about these bullets. • - I got her pre-release plan with a list of resources to assist with pregnancy. I asked them to firm up plan a bit and will send for your review if you would like to see it. I have also attached the resources close to her house that will assist with her post release services and are close to her future address of, Again this is still tentative and any additional resources • o Potential foster care is identified by approved providers after referral for this level of care by program and approved by FFS. these houses are homes that have been awarded a grant to house UAC by ACF-ORR. they have to be licensed to accept our kiddos. Thank you again for your trip, I learned from you and I hope you take your experience here in San Antonio and we have set the bar high. I always push my teams to be the best and our providers to provide best services in the nation, so what you saw is SOP on a daily basis. CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00010950 Case 3.16rcvr03539rLB Document 845 Filed 10/05/17 Page 3 0M Safe travels sit, and it was pleasure to have met you. look forward to working for you at ow please feel free to reach out to me if you should have any questions concerning any uc in the Central Texas or chicago AOR. PS: have included my immediate Supervisor Mr, James De La Cruz on email as he is that al knowing all seeing UAC Oraclem LOL, He can also assist with any questions when it comes to our kiddos and level of care amazing man that has steered this ship overseeing more than 175,000 kiddos in the last fiye From: Lloyd, scott (ACF) Sent. Tuaday, March 14, 2017 1:51 PM To: Subject: Quick thoughis lust a few things, while they are fresh in my mind: said she preferred the food at Semnithat it wasn't Honduran enough at lshe mentioned bananas, which thought BCFS has, and soup). lf there is a way to accommodate at BCFS with any food requests, please find a way. She's feeling very nauseous because ofthe pregnancy. 2) she also says she has pain in her arms and legs at night and thinks it might be the mattress. This is one to keep in mind, ilthere is an extra mattress laying around, maybe plywood instead of the planks underneath as you were saying atthe extended care facility, maybe foam or something on top of the mattress. Something to look int 3) -please have her clinlcian keep a close on her. As We said, often these girls startto regret abortion, and ifthis comes up, we need to connect her With resources for and or religious counseling. It's not going to affect some girls right away or at all. lfthere are any additional updates on her case, l'd like to know. 4) lfthings get dicey with -sponsor, I know a few good families With a heart forthese situations who would take her in in a heartbeat and see her throu her re nanc and be and said she would acce this ifthin can't work out with her aunt soon, That's all can think of right now, Thanks again for eyerything. and for the hard work and dedication of you and your team. Scott as E, Scott Lloyd Deiarlment of Health and Human Sen/Ines 7 Subject (0 Protective Order Case Document 845 Filed 10/05/17 Page 4 0M 7 Subject to Protective Order Case 3:16-cv-03539-LB Document 84-6 Filed 10/05/17 Page 2 of 2 Cc: Subject: RE: Heads up: UC requesting pregnancy termination Great, I will let the staff asking me know. Thank you for the prompt reply. From: Lloyd, Scott (ACF) Sent: Tuesday, April 04, 2017 4:31 PM To: White, Jonathan (ACF) Cc: Subject: Re: Heads up: UC requesting pregnancy termination Yes-- they were going to a CPC site today and we're going to proceed to discharge according to my understanding. Thank you, Scott On: 04 April 2017 16:06, "White, Jonathan (ACF)" wrote: Scott, Jonathan From: Lloyd, Scott (ACF) Sent: Saturday, April 01, 2017 8:48 PM To: White, Jonathan (ACF) Cc: Subject: Re: Heads up: UC requesting pregnancy termination Thx Jonathan. I'll be in the office Monday and half of Tuesday. On: 01 April 2017 16:47, "White, Jonathan (ACF)" wrote: Scott, Jonathan CDR Jonathan White Deputy Director for Children's Programs Office of Refugee Resettlement Administration for Children and Families 2 CONFIDENTIAL - Subject to Protective Order PRICE_PROD_00010616 Case 3:16-cv-03539-LB Document 84-6 Filed 10/05/17 Page 2 of 2 Cc: Subject: RE: Heads up: UC requesting pregnancy termination Great, I will let the staff asking me know. Thank you for the prompt reply. From: Lloyd, Scott (ACF) Sent: Tuesday, April 04, 2017 4:31 PM To: White, Jonathan (ACF) Cc: Subject: Re: Heads up: UC requesting pregnancy termination Yes-- they were going to a CPC site today and we're going to proceed to discharge according to my understanding. Thank you, Scott On: 04 April 2017 16:06, "White, Jonathan (ACF)" wrote: Scott, Jonathan From: Lloyd, Scott (ACF) Sent: Saturday, April 01, 2017 8:48 PM To: White, Jonathan (ACF) Cc: Subject: Re: Heads up: UC requesting pregnancy termination Thx Jonathan. I'll be in the office Monday and half of Tuesday. On: 01 April 2017 16:47, "White, Jonathan (ACF)" wrote: Scott, Jonathan CDR Jonathan White Deputy Director for Children's Programs Office of Refugee Resettlement Administration for Children and Families 2 CONFIDENTIAL - Subject to Protective Order PRICE_PROD_00010616 Case 3:16-cv-03539-LB Document 84-8 Filed 10/05/17 Page 2 of 3 4.) If the UC has not had her ultrasound yet, she should do so at the following place: http://www.cpcphoenix.org/ If she has had it, she does not need an additional ultrasound, but the grantee I field staff should set up a session of options counseling there. 5.) After the options counseling, if the UC still desires the abortion, and it is still within the window for a legal abortion, the UC must obtain parental consent, which will necessitate options counseling with them, plus signed, notarized declaration of consent. 6.) The UC should not be meeting with an attorney regarding her termination or otherwise pursuing judicial bypass at this point. Please continue to update us as the stated guidance is being followed. If you have any questions please feel free to contact or me. From: White, Jonathan (ACF) Sent: Friday, March 24, 2017 12:04 PM To: Cc: De LA Cruz, James (ACF); Sualog, Jallyn (ACF); Swartz, Tricia (ACF); Subject: FW: Heads up: UC requesting pregnancy termination , I am writing to provide follow-up guidance from HHS Policy Team on the UC at SWK Casa Las Pal mas who has requested abortion services Please see guidance below from Scott Lloyd. It covers next steps. Please let me know if you have any questions but please communicate with the medical provider and management of the shelter regarding these next steps. Don't hesitate to let me know any questions and please have SWK continue to update as plan elements are implemented. It sounds like gestational age is the next big question. Thank you. Jonathan From: Lloyd, Scott (ACF) Sent: Friday, March 24, 2017 11:21 AM 6 CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00010709 Case 3.16scvs03539sLB Document 848 Flled 10/05/17 Page 3 of 3 To White, Jonathan (ACH Cc: rota, Kenneth (ACF), Bowman, Matthew ths/oec) Subject: RE, Heads up: uc requesting pregnancy termination lonathan, As things stand now, the unoorn child is a child our care, so the medreal team should continue with standard prenatal care, as oelieye is already the procedure. it looks lrke there are issues in addition to the pregnancy, as she mentioned and the destnoes her demeanor as "obnoxious" and "sad," Clinioan should work to identity any pressures that might be leading her to desire termination (does she leel pressure to get to work, is there emotional ahuse, etc and what is leading to her sadness and anger. lam sure some at this work has already commenced, but it bears mention, Along these same lines, let's make sure that she is aware or the option or haying spiritual Counseling that is sensitiye to her religious prelerence. Additionally, it she has not had her ultrasound yet, she should do so at the iollowing plaee epephoenrx org/ If she has had it, she does not need an additional ultrasound, out the grantee held start should set up a session or options counseling there Once we know the gestatronal age, that be material, as it may already he too late to legally ootain an abovtlon. Atter the options counseling, it she desires the aoortion, and it is within the Window for a legal abortion, she must obtain parental consent, which necessitate options counseling with them, plus signed, notanzed declaration or consent, she should not be meeting With an attorney regarding her termination or otherwise bypass at this point We'll work on these procedures, but we'll have to do it ad hoc 10V now Thank you, Scatt E, Scott Lloyd us. De artment of Health and Human Seryices 7 Subject (0 Protective Order Case 3.16ecve03539eLB Document 849 Flled 10/05/17 Page 2 of 3 From: De LA Cruz, James (ACF) Sent: Monday, Apnl 03, 2017 5:01 PM To: whrte, Jonathan (ACFJ Cc: Sualog, Jallyn (ACF) Subject: Cllent Attachments: Hello Jonathan, As or alternoon the program has rnrormea the Uc mother and sponsor about the pregnancv The #5 has approved the release and the program ls to transport the to her sponsor\orother. asked the FPS to 5(hedule the transport no sooner than 48 hours from now In the eyentthat Serllor Management has another request to Please also see the attachments sent oy the #5 last Frlday and today. James S. De La Cruz Senlor Federal Fletd Speciallst Supervisor Office of Refugee Resettlement Dlulsion of Sewlces Mary E. 5wltzer 5th Flam (Room: 5223) 330 Street sw Washln ton DC 20201 acf hhs. ov ro rams arr r0 rams ucs From: White, Jonathan (ACF) Sent: Thursday, March 30, 2017 1:17 PM To: De LA Cruz, Jams (ACF) Cc: Sualog, Jallyn (ACF) Subject: Fw: Kokopelli Cllent Jlm, Please Scatt's drreetron, below, through team to program, re Uc release at Let me know lf there are any questlons. Jonathan CDR Jonathan whlte Deputy Dlrector for Children's Programs othce of Refugee Resettlement 7 Subject to Protective Order Case Document 849 Filed 10/05/17 Page 3 of 3 for Chimren and Varmh'es Inctdenl Commander Unaccompamed Cthren Influx Response From: Lloyd, Scott IACF) Sent: Thursday, March so, 2017 1:11:29 PM To: white, Jonathan (ACF) Subject: RE: Kokopem Client Thank vomithe grantee or the tederat netd start must notth her parents of the termmatlon rn Case This shoutd happen of (esources to the UAC for postrabortton counsehng as part or postrretease care. Please let me know there are any ouestrons. Scott From: White, Jonathan (ACF) Sent. Wednesday, March 29, 2017 10:07 PM Ta: Ltoyd, Scott (ACF) Subject: Fw: Kokopelli Chant 0n the 0c you asked me about today-she rs Dur care whne her trauet arrangements are nnahzed CDR Jonathan Whtte Deputy Drrertar for Children's Programs ornce of Refugee Resettlement for and Pamrhes Incrdent Commander Unaccompamed Influx Response From: De LA Cruz, James (ACF) Sent: Wednesday, March 29, 2017 9:57:54 PM To: white, Junathan (ACF) Subject: Fw: Kukopelh client - informed me the program rs making travet arrangements. She rs physicalty at the program. From: De LA Cruz, James (ACF) Sent: Wednesday, March 29, 2017 1:04:10 PM To Su Kokopel Can you find out rrshe has \eft. If not does she have a trayet date. 7 Subject to Protective Order Case 3:16-cv-03539-LB Document 84-10 Filed 10/05/17 Page 2 of 2 From: Sent: Friday, March 31, 2017 8:03 PM De LA Cruz, James (ACF) To: Cc: Subject: Attachments: FW: Best Interests Recommendation for of pregnancy Termination Mr. De La Cruz, I have attached the emails forwarded by the program, SWK Kokopelli, and by the assigned UC Child Advocate outlining their concerns in regards to the directives provided by ORR Headquarters in this case. I have reviewed the information and advised that I would be elevating the concerns. Based on our staffing today, the review of the directives, and to provide clarity to said directives, the program and myself are being directed to: (1) Immediately advise the UC that her mother will be notified and provided with information that; UC was impregnated in COO, UC terminated said pregnancy in the United States while in ORR Care despite the UC's affirmative declaration to keep said personal health information confidential. (2) Immediately reeva luate the psychologica l state of UC after said disclosures and assess whether the UC is still willing to pursue placement with the current UC Sponsor, the UC's biological brother. a. b. If the UC desires to proceed with stated placement, the UC will be advised that the UC Sponsor, the UC's biological brother, will also be advised that; UC was impregnated in COO and further that the UC terminated said pregnancy in the United States while in ORR Care, despite the UC's affirmative declaration to keep said personal health information confidential. If the UC refuses to continue with stated placement, the program is to proceed with the disclosures noted in paragraph one and pursue contingent planning for the UC's placement with an alternate sponsor or for UC to continue in ORR care. Thanks for your attention on this matter. CONFIDENTIAL - Subject to Protective Order PRI CE_PROD _00010623 Case 1:17-cv-02122-TSC Document 18-5 Filed 10/18/17 Page 2 of 3 Gregg, Bobbie (ACF) From: Wolff, Kate (ACF) Wednesday, February 24, 2016 3:36 PM Gregg, Bobbie (ACF); Cancian, Maria (ACF) RE: 5:00 PM Meeting with Deputy Secretary Sent: To: Subject: Late breaking update! From: Wolff, Kate (ACF) Sent: Wednesday, February 24,20163:34 PM To: Gregg, Bobbie (ACF); Cancian, Maria (ACF) Subject: RE: 5:00 PM Meeting with Deputy Secretary We are still working to get a final reconciled numbers for 2015, but here is a little more info: Calendar Year 2014 Pregnancies 726 Terminations 5 (4 funded by ORR) Calendar Year 2015 - Unreconciled Pregnancies 450 est. Te rm i nations 12 (6 funded by ORR) From: Gregg, Bobbie (ACF) Sent: Wednesday, February 24, 2016 2:45 PM To: Cancian, Maria (ACF) Cc: Wolff, Kate (ACF) Subject: 5:00 PM Meeting with Deputy Secretary CONFIDENTIAL - Subject to Protective Order Bobbie Gregg Deputy Chl'dren's Services office of Refugee Resettlement 7 Subject (0 Protective Order Case Document 18-6 Filed 10/18/17 Page 2 of 3 From: White, Jonathan (ACF) [Jonathan.White@ACF.hhs.gov] Sent: 2:45:22 AM To: Tota, Kenneth (ACFI [kenneth.tota@act.hhsgov] CC: Subject: RE: pregnant girls estimate From: Tota, Kenneth Sent: Thursday, March 09, 201? 9:45 PM To: White, Jonathan (ACF) Cc:? Subject: Re: pregnant girls estimate On: 09 March 201? 19:34, "White, Jonathan wrote: Update: we now have the list of programs identified as having one or more pregnant UC sheltered: Currently housing at least 1 pregnant UC as of 3f8f2017: 1. BCFS San Antonio 2. BCFS San Antonio TFC 3. Bokenkarnp TFC 4. CC Fort Worth LTFC 5. CC Houston 6. Crittenton Shelter 7. Brownsville 8. Driscoll 9. Harlingen 10. IES Hidalgo ll. IES Palm Vallev 12. IES San Benito 13. Seton Home 14. Southwest Key Campbell 15. Southwest Kev Casa Phoenix 16. Southwest Kevr Case Quetzal 17. Southwest Kes,r Glendale 18. Youth For Tomorrow Several of these are programs with faith?based objections to participating in abortion. We will do some targeted outreach tomorrow to the others. Jonathan CONFIDENTIAL Subject to Protective Order 1631 Case 1.17ncv7021227TSC Document 1876 filed 10/18/17 Page 3 of 3 CDR Jonathan whrte Deputy Dwrector to! Programs Olflce 0| Relugee Resett'er'vent Administranon iov cnnaren and Fammes \nmdent Commander, Uneceornpanreu Children \nHux Response Frpm: White, Jonathan (ACF) Sent: Thursday, March 9, 2017 656,36 PM Yo: Tm, Kenneth (ACF) -- 5mm, rw, pregnem 5m; estrmeu Ken, To respond to Scott's request earher week, the DHUC staff and DUCO Data Team have rpennlred 25 pregnanrgir/s currentlyin wan cure as of yesterday's date They are .n 13 prugvams have asked to have rdenunep rf so we can speucrcauy foHow up with each ms esxrmete rs based on a ofdata puHed Tveatment Auznormtron Requests, UAC Medrcm Nodu'e Perm data, Serrous \nmdent Reports, and venfmatlon (5H3 the pvugrams As rnpreezedm Scott week, this Is not low iuo'pmofdata but our best avm'able estimate [mm the data \wm to Scan ance van OK me to do so Jonathan -- Subjecl to Protective Order 1632