In May 2007, Victoria Arellano, a 23-year-old transgender immigrant from Mexico, was sent to a detention center in San Pedro after being arrested on a traffic charge.

Arellano, who was born a male and had come to the United States illegally as a child, had AIDS at the time of her arrest but exhibited no symptoms of the disease because of the medication she took daily. But once detained, her health began to deteriorate.She lost weight and became sick. She repeatedly pleaded with staff members at the detention center to see a doctor to get the antibiotics she needed to stay alive, according to immigrant detainees with whom Arellano shared a dormitory-style cell. But her requests were routinely ignored.

The task of caring for Arellano fell to her fellow detainees. They dampened their own towels and used them to cool her fever; they turned cardboard boxes into makeshift trash cans to collect her vomit. As her condition worsened, the detainees, outraged that Arellano was not being treated, staged a strike: They refused to get in line for the nightly head count until she was taken to the detention center's infirmary.

Officials relented, and Arellano was sent to the infirmary, then to a hospital nearby. But after two days there -- and after having spent two months at the federally operated facility -- she died of an AIDS-related infection. Her family has taken steps to file a wrongful-death claim against the federal government.

The treatment Arellano received in San Pedro, unfortunately, is typical of what passes for healthcare at about 400 immigrant detention centers across the U.S. More than 70 immigrant detainees have died in custody since 2004, at least 13 of them in California, more than in any other state, according to U.S. Immigration and Customs Enforcement.

The reason may shock you. Unlike federal and state prisons, immigrant detention centers, many of which are run by private contractors, are not legally mandated to abide by any healthcare standards when it comes to treating sick immigrants. Civil and immigrant rights groups have filed suit in New York to force federal officials to issue such rules, but the Department of Homeland Security, which has jurisdiction in the matter, has yet to produce them. In the absence of legally binding standards, detained immigrants, such as Arellano, have no legal way to complain about the lax healthcare they receive at the facilities where they are held. They cannot appeal the denial of care or sue in federal court to obtain it.

What medical care is available is often delayed, or denied, while doctors and nurses at the facilities await approval from officials in Washington, who can deny crucial care without explanation