Health care services provided to detained immigrants are inadequate to provide for the needs of this population. We analyzed the medical care policies and procedures for immigrants in detention, government reports on detainee medical care, and available mortality and morbidity data. We conclude that the current system of medical care for this vulnerable population needs improvement. We suggest that a federal legislative solution is one essential component to address this issue and improve medical care. Principles to be embodied in a legislative proposal necessary to address the inadequacies in the current system are presented.