MIAMI - U.S. immigration authorities routinely delay, deny or botch medical care for immigrants in detention, according to separate reports by two advocacy groups released Tuesday.

Meghan Rhoad, center, a researcher for Human Rights Watch, looks to former detainee Marlene Jaggernauth, right, as she speaks during a news conference along with Cheryl Little, left, executive director of Florida Immigrant Advocacy Center, Tuesday, March 17, 2009 in Miami. U.S. immigration authorities routinely delay, deny or botch medical care for immigrants in detention, according to separate reports by the two advocacy groups released Tuesday. (AP Photo/Wilfredo Lee) Human Rights Watch and the Florida Immigrant Advocacy Center said immigrants detained by U.S. Immigration and Customs Enforcement routinely receive inadequate medical care in poorly equipped facilities nationwide.

They blame the problems on unskilled or indifferent staff, overcrowding, bureaucratic red tape, language barriers and limited services available to detainees. The groups contend that many medical problems could be avoided if the agency did not lock up people who are elderly, have health issues or lack criminal records.

Advocates argue that alternatives to detention, like requirements to check in by phone or in person, are "more humane" and cost taxpayers as little as $12 a day, compared with $95 a day to keep someone in immigration custody.

"ICE needlessly detains people with severe illnesses and those who pose no harm to U.S. communities. Doing so drives up ICE costs even as the agency provides increasingly inadequate medical and mental health care to those in its custody," said Cheryl Little, FIAC's executive director.

ICE detained more than 300,000 people in the fiscal year 2007, with a daily average of nearly 30,000. Most were held in state and county jails under contracts with ICE. Some detainees are held for months, even years, though ICE says the average time is 31 days.

The agency responded that its Division of Immigration Health Services gives detainees general and emergency health care, dental, chronic and mental health care.

"ICE is committed to providing all detainees in our care with humane and safe detention environments and ensuring that adequate medical services are provided to all in our care with timely and appropriate treatment, to the tune of nearly $100 million annually," ICE spokeswoman Nicole Navas said.

Current and former detainees around the country complained that medical staff at ICE facilities routinely violated their own standards in areas including continuity of care, quick response to medical complaints, informing inmates about the availability of services and providing medical screenings and follow-up care.

Female detainees particularly suffered because routine reproductive health issues failed to receive adequate attention in a system that emphasized emergency care and treating conditions that might affect a detainee's deportation status, according to Human Rights Watch.

Women told the group's researchers that they had been shackled while pregnant, missed appointments for mammograms and Pap smears or failed to receive prenatal care while in immigration custody.

"This overall approach, as well as specific restrictions on Pap smears, hormonal contraception, and access to specialist care, undermined the health of a number of women," according to the Human Rights Watch report.

Some inmates and former detainees told advocates that they eventually dropped their requests for medical care or refused follow-up treatment to avoid being shackled in transit or because they believed their attempts to obtain adequate care were futile. They also reported that security officers inhibited their access to medical care by refusing to call medical staff or violating their privacy by openly discussing their health problems and observing medical exams.

A former detainee who spent 11 months in ICE custody said she and fellow inmates languished without proper care in four different county jails in Florida. Mentally ill women were sent to solitary confinement, sleeping inmates weren't wakened when medications were distributed and guards refused supplies to menstruating women, said Marlene Jaggernauth, 43, a native of Trinidad. She said her own request to see a gynecologist needed approval from ICE officials in Washington, which never came.

"Part of the problem is that officers are not trained and they don't really understand what a detainee means," said Jaggernauth, whose case was finally resolved in June, five years after she was initially detained in 2003. "They think that all immigration detainees are just going to be deported, so they can be ignored."

Advocates allege that the inadequate medical care may have contributed to the deaths of some detainees in ICE custody or soon after their release. FIAC's report cites the deaths of two men whose cancers went untreated, a man whose cardiac infection went untreated, an elderly Haitian minister who was hospitalized in leg restraints after being accused of faking his violent vomiting and a young Haitian man who suffered from seizures and psychiatric problems.

According to ICE, 77 immigrants have died in detention in the last five fiscal years, although it did not specify the causes.

Advocates are not alone in criticizing ICE health care for detainees. The Department of Homeland Security's Office of Inspector General found instances of noncompliance with medical standards in 2006 and 2008 audits.