Report exposes deep healthcare gaps in the Northern Mariana Islands justice system

On June 25, 2025, the Northern Mariana Islands Advisory Committee to the US Commission on Civil Rights released a report that paints a stark picture of healthcare access within the NMI’s justice system. The study, Examining Access to Adequate Healthcare within the Northern Mariana Islands’ Justice System, draws on in-person visits, public hearings, and testimony from former inmates, healthcare workers, legal advocates, and government officials. It details widespread deficiencies in medical, mental health, and dental care for people held in custody.

Among the most pressing issues identified is the shortage of qualified medical professionals— particularly mental health providers— which leaves detainees waiting extended periods for treatment. The report describes how “DOC inmates continue to face barriers” despite having an on-site medical unit, citing delays in sick calls, a lack of trained staff, and no dental care.

Because of these gaps, the Department of Corrections frequently relies on off-site treatment through the CHCC (Commonwealth Healthcare Corporation). Yet, the report cautions that even with this arrangement, “inmates still encounter delays and obstacles through CHCC and other external providers,” pointing to inconsistent coordination and limited capacity.

Similar challenges extend beyond adult facilities. Juvenile detention centers and specialty courts—such as drug and mental health courts—fail to consistently provide the services participants require. As the committee notes, “juvenile offenders often go without necessary medical or mental health services,” and court participants face similar shortfalls. These gaps undermine the rehabilitative intent of the programs.

The committee also raised concerns about the treatment of pretrial detainees, warning that “the CNMI fails to ensure … freedom from unnecessary involuntary medication,” a practice that puts legally innocent individuals at risk.

In response to these systemic problems, the report calls for a series of reforms. It recommends clear and accessible grievance procedures, regular assessments to ensure adequate staffing, and the introduction of secure tablets for inmates to submit medical requests electronically. It also urges investment in an integrated electronic medical records system linking the Department of Corrections and the Commonwealth Healthcare Corporation, as well as expanding eligibility for alternative courts to reach more low-level offenders. To address capacity issues, the committee proposes increasing residential treatment facilities on Saipan.

“Safeguarding the rights of individuals within CNMI’s justice system to access adequate healthcare has been a serious ongoing problem and concern in the Commonwealth of the Northern Mariana Islands for decades,” NMI Advisory Committee Chair Catherine Cachero said. “The Committee hopes that the various federal and local policymakers and authorities carefully consider the findings in our report and adopt the recommendations made in the report to ensure equal and adequate healthcare to all members of our community.”

The release of this report comes at a critical moment for the Northern Mariana Islands, where geographic isolation, limited resources, and strained infrastructure complicate the delivery of public services. By placing the justice system’s healthcare failures under public scrutiny, it challenges both local and federal authorities to take action. For advocates, it offers a clear roadmap to strengthen human rights protections for some of the territory’s most vulnerable residents, and for policymakers, it is a call to close long-standing gaps before they become further entrenched.