The bill adds a new section (18 U.S.C. §251) making it unlawful for specified federal custodians to negligently fail to obtain or provide immediate medical attention to a person in federal custody who displays medical distress, if that failure causes unnecessary pain, injury, or death. It applies to federal law enforcement officers, Bureau of Prisons employees, and U.S. Marshals Service personnel; the penalty is a fine, up to one year imprisonment, or both.
Beyond criminal sanctions, the measure requires the appropriate Inspector General to investigate incidents that meet the statute’s elements, to operate a confidential complaint channel, and to refer negligent cases to the Attorney General for prosecution. It also gives state attorneys general a civil enforcement hook to seek equitable and declaratory relief and obligates agencies that employ covered officials to provide training on obtaining or giving medical assistance.
At a Glance
What It Does
Creates a federal misdemeanor for negligent failure by certain federal custodians to secure or provide immediate medical care to detainees in medical distress when that omission causes unnecessary pain, injury, or death; sets penalties up to one year in jail. Requires IG investigations and referrals, authorizes state AG civil suits, and mandates agency training.
Who It Affects
Covered officials: federal law enforcement officers (per 18 U.S.C. §115 definition), Bureau of Prisons staff, and U.S. Marshals Service employees. Also affects agency Inspectors General, the Department of Justice (as prosecutor), state attorneys general, and people held in federal custody.
Why It Matters
The bill creates a criminal accountability route for omissions by federal custodians rather than relying solely on civil litigation or employment discipline. It couples criminal exposure with IG oversight and a new state-level civil enforcement tool, which could change how agencies respond to medical emergencies and how oversight resources are allocated.
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What This Bill Actually Does
The core operative text inserts a single new statutory section into chapter 13 of title 18. That section first sets basic working definitions: it lists who counts as a covered official (federal law enforcement officers, Bureau of Prisons employees, and U.S. Marshals Service personnel), identifies which Inspector General should handle complaints, and explicitly notes that “medical distress” includes breathing difficulties.
The definitions control how the rest of the section applies and where oversight responsibility sits.
The bill makes it a crime for a covered official to negligently fail to obtain or provide immediate medical attention to someone in federal custody who is displaying medical distress, but only when that failure results in unnecessary pain, injury, or death. The statute uses negligence as the culpable mental state rather than deliberate indifference or intent; conviction exposure is a misdemeanor punishable by a fine, up to one year imprisonment, or both.
The text ties the criminal element to a causation requirement—the injury, pain, or death must result from the omission.Oversight and enforcement are multi‑layered. The appropriate Inspector General must investigate any qualifying incident and, if the IG concludes the covered official acted negligently, refer the matter to the Attorney General for prosecution.
The bill also requires each agency that employs covered officials to create a confidential complaint process with its IG so individuals can report incidents without direct retaliation. Separately, the statute authorizes state attorneys general to bring civil actions in federal court to obtain equitable and declaratory relief when a state resident has been harmed by a covered official’s failure to act.Finally, the bill requires agencies to train covered officials on obtaining or providing medical assistance to people in medical distress.
The text makes a technical change to the table of sections for chapter 13 to add the new provision; it does not appropriate funds or prescribe training standards. Implementation will therefore rely on agency rulemaking, IG capacity, DOJ prosecutorial decisions, and state attorneys general using their new civil enforcement authority.
The Five Things You Need to Know
The bill inserts 18 U.S.C. §251, which criminalizes negligent failure by specified federal custodians to obtain or provide immediate medical attention when a detainee displays medical distress that leads to unnecessary pain, injury, or death.
Conviction carries a misdemeanor penalty: a fine, imprisonment for up to one year, or both.
The statute requires the appropriate Inspector General to investigate qualifying incidents, operate a confidential complaint channel, and refer cases to the Attorney General when negligence is found.
State attorneys general may sue in federal court to obtain equitable and declaratory relief on behalf of state residents allegedly harmed by a covered official’s failure to act.
Federal agencies that employ covered officials must provide training on obtaining or providing medical assistance, but the bill does not set curriculum standards or provide funding.
Section-by-Section Breakdown
Every bill we cover gets an analysis of its key sections.
Short title
Designates the bill as the 'Andrew Kearse Accountability for Denial of Medical Care Act of 2025.' This is purely nominal and does not affect substantive duties or enforcement.
Who is covered and what counts as medical distress
Defines 'covered official' to include federal law enforcement officers (the text cross-references the statutory definition at section 115), Bureau of Prisons employees, and U.S. Marshals Service personnel. It also prescribes the 'appropriate Inspector General' as the agency IG or, if an agency lacks an IG, the Department of Justice IG. The provision explicitly states that 'medical distress' includes breathing difficulties, which anchors the statute to observable acute conditions but leaves other symptoms open to interpretation.
Creates misdemeanor for negligent omission and enables state enforcement
Makes it unlawful for a covered official to negligently fail to obtain or provide immediate medical attention when a detainee displays medical distress and needless harm results. The statutory elements require proof of negligence and causation to the point of unnecessary pain, injury, or death. Penalties are limited to misdemeanor sanctions. Separately, the subsection gives state attorneys general standing to bring civil actions in federal court to seek equitable or declaratory relief on behalf of harmed residents — an unusual federal statute that deputizes state enforcement rather than creating a private federal cause of action.
Mandatory Inspector General investigations, confidential complaints, and referral duty
Obligates the appropriate Inspector General to investigate any incident where a covered official’s omission meets the statute’s elements and the individual suffers unnecessary pain, injury, or death. If the IG concludes the official acted negligently, the IG must refer the matter to the Attorney General for possible criminal prosecution. The provision also requires agency IGs to offer a confidential complaint process, which could expand intake of allegations but also increases IG caseloads and evidentiary demands.
Training requirement and technical changes
Requires agency heads to provide training to covered officials on obtaining or providing medical assistance to individuals in distress. The bill does not specify training content, frequency, certification, or funding. Finally, it amends the chapter table of sections to list the new section, a bookkeeping change with no substantive effect.
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Explore Criminal Justice in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- People detained by federal authorities: the statute creates an explicit legal remedy route and oversight mechanism intended to reduce harmful omissions and improve timely access to care.
- State attorneys general and state-level enforcement offices: gain a statutory basis to sue in federal court for equitable and declaratory relief when state residents are harmed, giving them leverage to compel remedial measures.
- Inspectors General and oversight organizations: receive a statutory mandate and a confidential intake requirement that can expand detection of incidents and trigger systemic investigations.
- Families and advocates of detainees: obtain clearer avenues to press for investigations, referrals to DOJ, and state-led civil remedies, increasing pressure for transparency and accountability.
Who Bears the Cost
- Covered officials (federal law enforcement, BOP, USMS personnel): face criminal exposure for negligent omissions and may confront increased administrative and legal scrutiny; agencies may discipline and defend employees more often.
- Federal agencies employing covered officials: must develop and run training programs, support IG complaint channels, and potentially defend against state AG lawsuits — all without an appropriation in the bill.
- Inspectors General offices: will absorb added investigative workload from required inquiries and confidential complaints, potentially necessitating more resources or reprioritization of oversight activities.
- Department of Justice: will receive more IG referrals and must decide prosecutorial priorities for misdemeanor negligence cases, which could strain resources or shift focus from other matters.
Key Issues
The Core Tension
The bill seeks to strengthen accountability for life‑and‑death omissions by turning negligent failures into a prosecutable offense while relying on IG oversight and state civil suits to fill enforcement gaps — but that same criminalization can strain investigative and prosecutorial resources, produce uneven enforcement across jurisdictions, and risk either under‑prosecution of culpable omissions or a chilling effect that changes custodial behavior in unpredictable ways.
The bill criminalizes negligence in the custody context, which is analytically and operationally different from civil liability or findings of deliberate indifference. Proving negligence plus causal linkage to unnecessary pain, injury, or death requires investigators and prosecutors to assemble medical evidence, timelines, and witness accounts—tasks that demand IG and prosecutorial resources.
The statute’s misdemeanor ceiling further creates a practical question of prosecutorial incentive: prosecutors must decide whether misdemeanor charges best serve accountability goals or whether other avenues (administrative discipline, civil suits) are more appropriate.
Several implementation gaps create real risks. The training mandate lacks content standards, certification, or funding, so compliance could be uneven across agencies and facilities.
The confidential complaint requirement shifts intake volume to IG offices that may not have the staffing to promptly investigate every allegation. Allowing state attorneys general to sue introduces potential for uneven remedial outcomes across states and could generate conflicting federal‑state expectations about custody practices.
Finally, the statute relies on an IG referral to the Attorney General rather than automatic prosecution, preserving prosecutorial discretion but also potentially leaving serious misconduct unprosecuted.
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