He survived Russia’s invasion of Ukraine, evacuated women and children in Kyiv to safety, and then crossed the border to escape the war.

But after he arrived at the Krome North Service Processing Center in southwest Miami-Dade County, Maksym Chernyak, 44, suffered a stroke. Staff took more than 40 minutes to call 911. Later that day, on Feb. 18, a doctor wrote that Chernyak had irreversible brain damage. He died two days later.

“In neurology we have a saying that is ‘time is brain’ — meaning that every minute a stroke is not treated is brain tissue lost or damaged,” said Altaf Saadi, a neurologist at Massachusetts General Hospital and associate professor of neurology at Harvard University.

Chernyak’s death came about a month after a 29-year-old Honduran man also held at the immigration detention center died of “complications of schizoaffective disorder.” The autopsy ruling for Genry Ruiz-Guillen shocked doctors, who described it as an insufficient explanation for how he might have died.

While the Miami-Dade Medical Examiner Department ruled that both men died of “natural” causes, a Miami Herald investigation found evidence of what experts described as questionable medical care for the two immigrants.

Between December and April, four people died in immigration detention in Florida, accounting for half of all fatalities in U.S. Immigration and Customs Enforcement custody so far in fiscal year 2025, which runs from October 2024 through September 2025. The most recent death was of 44-year-old Marie Ange Blaise, who died on April 25 at the Broward Transitional Center in Pompano Beach. Officials have not yet released her cause of death.

Reporters obtained more than 150 pages of autopsy, toxicology, death reports, and available medical histories for Chernyak, Ruiz-Guillen and a 60-year-old Guyanese immigrant who died in December. The Herald consulted with nine medical experts — including cardiologists, neurologists, psychiatrists and a forensic pathologist — who reviewed records for one or more of the cases. They were alarmed at the treatment of Chernyak and Ruiz-Guillen and questioned whether they got adequate care.

Chernyak’s case was heartbreaking, Saadi said. “There was this neurological emergency — someone who was not responsive after a seizure — and a medical professional did not activate 911 for 45 minutes.”

ICE officials have yet to respond to a detailed list of questions explaining the men’s deaths. On April 7, reporters requested internal mortality reviews and additional medical records, but the request is still pending. The Herald was told that footage of Ruiz-Guillen’s time at Krome is not available, because the agency does not keep videos longer than 60 days.

In an emailed statement to the Herald, an ICE spokesperson wrote that detainees receive medical screening within 12 hours of arrival at a detention center, and a full health assessment in the first 14 days. The ICE Health Service Corps has over 1,600 employees and 24-hour emergency care nationwide.

“U.S. Immigration and Customs Enforcement prioritizes the health, safety, and well-being of all aliens in its care and remains committed to ensuring that all those in its custody reside in safe, secure, and humane environments,” the spokesperson wrote. “At no time during detention is a detained individual denied emergent care.”

Ruiz-Guillen had spent more than a month at Krome, where he suffered from seizures and confusion, before he was eventually admitted to Larkin South Community Hospital, part of the Larkin Health System. He was moved to three Larkin hospitals in the following month as his symptoms continued. His toxicology report shows numerous medications in his system.

Michael Baden, a former chief medical examiner of New York City, has conducted more than 20,000 autopsies and investigated high-profile deaths, including those of Medgar Evers and George Floyd. He reviewed the autopsies and said the finding that Ruiz-Guillen died of “complications of schizoaffective disorder” does not answer the question of how he died.

“Mental illness, by itself, is not a proper cause of death,” Baden said. “In this instance, it’s the complications of the mental illness that’s important, and the complications that I see are too many drugs in his system.”

A death report shows Ruiz-Guillen had a potentially fatal, muscle-breakdown condition called rhabdomyolysis, which Baden said can develop in people who have been restrained. A spokesperson for the Larkin Health System declined to share Ruiz-Guillen’s medical records, citing privacy laws.

“We cannot comment on any details surrounding a specific patient,” Patricia Vila said in an emailed statement to the Herald. “Patient confidentiality is required by law and ensures respect for the deceased and their family.”

Joshua A. Gordon is the chair of the Department of Psychiatry at Columbia University. He reviewed the autopsy, toxicology and death reports and said that without hospital records it’s unclear how the drugs in Ruiz-Guillen’s system were administered. But he too questioned the number of drugs — three anti-psychotics and an antidepressant. He said the weeks of rhabdomyolysis are “most concerning” and can be indicative of a poor reaction to medication.

“If all four drugs were being simultaneously administered,” he said, “I would consider that a departure from standard of practice, highly unusual and potentially dangerous.”

‘Patient appeared intoxicated’

Chernyak and his long-term partner, Oksana Tarasiuk, were living together in Kyiv when Russian troops poured across the border in February 2022. Tarasiuk said they fled soon after the war began.

“We were basically fleeing all of that: the horror, the pain, the destruction,” Tarasiuk said through an interpreter. “We’ve lost everything we had in Ukraine.”

Tarasiuk described her partner as “kind and warm-hearted.” He has one child from a previous relationship, and his parents still live in Ukraine.

“Maksym was not just the person I loved,” she said. “He was also someone to lean on, and my hope.”

On Jan. 26, Chernyak was arrested and charged with domestic battery, records show. Tarasiuk told the Herald it was a “family misunderstanding,” worsened by a language barrier with police. Records show she submitted an affidavit days later to have the case dismissed. But it was too late.

The day that he was arrested, ICE requested that local law enforcement transfer him to the agency’s custody under a policy known as an “immigration detainer.” On Feb. 2, a Broward County jail released him to Krome.

Krome is a federal facility designed to hold immigrants awaiting legal proceedings or deportation. It frequently treats patients with chronic illness in its medical clinic. In recent months, detainees and their families told the Herald the facility was at a breaking point, with “inhumane” conditions and overcrowding.

One man, who was also held at Krome in February, told reporters that rooms were so packed detainees were practically sleeping on their feet.

Chernyak’s medical screening at Krome, obtained by the Herald, was noted to be “normal” with slightly elevated blood pressure — but no previous reported medical conditions, seizures, head injuries, or substance abuse. He was given a form written in Russian on how to reduce stress.

In the following two weeks, nurses logged slightly elevated blood-pressure levels for Chernyak two more times. Under guidelines from the American College of Cardiology/American Heart Association, the levels met standards for hypertension.

On Feb. 18, at 2:32 a.m., Krome staff reported a medical emergency and found Chernyak vomiting on his top bunk bed. His leg was shaking.

He showed “seizure-like activity” and his eyes were non-reactive to light. According to a nurse’s narrative written several hours later, officers and nurses put him in a wheelchair to take him to Krome’s clinic, but he slid onto the floor, unable to even sit.

“Patient appeared intoxicated,” the nurse wrote.

Amid worsening symptoms, staff brought him to the facility clinic and decided to rule out intoxication, records show. The nurse wrote that he had five seizures in about 25 minutes between 3:20 and 3:45 a.m. She “called 911 at this time,” according to medical records from Krome.

Miami-Dade Fire Rescue documents show 911 first received a call at 3:17 a.m. — more than 40 minutes after the emergency had started. The first ambulance arrived at Krome at 3:28 a.m., fire rescue records show, and a second arrived at 3:49 a.m. to transport him to a hospital.

Hilder Lainez-Alvarez, 37, a married father of five from Nicaragua, slept in the bunk below Chernyak for more than a week. He said that during the stroke, he and others told staff that Chernyak was not intoxicated.

“I have to go to a psychiatrist for what I have seen after the death of this poor man,” said Lainez-Alvarez, who is still at Krome and spoke to reporters on the phone.

Three neurologists who reviewed the records for the Herald said it’s hard to speculate, but had 911 been called earlier in Chernyak’s case, the story could have been different.

Saadi, the Harvard neurologist, questioned the response to treat him for intoxication, given he had been in a controlled detention center for nearly a month. She said she doesn’t “know why someone would assume that and not think more comprehensively about his clinic picture.”

“Treating the person sort of as promptly as possible and getting them medical care is of the utmost importance in terms of preventing mortality and morbidity,” she said. “It was just sort of this, you know, waiting to see what’s going to happen and that’s certainly substandard care.”

Around 4:40 a.m., Chernyak arrived at HCA Florida Kendall Hospital and doctors immediately initiated a stroke alert. An autopsy shows he had a hypertensive intracerebral hemorrhage in the part of the brain that controls a person’s ability to move.

Strokes like his are often caused by high blood pressure that damages or ruptures blood vessels in the brain. Studies show that symptoms worsen in the first 30 to 90 minutes, according to Harvard Medical School.

As soon as Tarasiuk heard, she rushed to the hospital with an interpreter. She wasn’t allowed to see him.

Two days later, she met with lawyers to discuss Chernyak’s case. The criminal charges against him were being dismissed, they told her, and they were preparing paperwork to remove him from ICE custody.

She was taken to a waiting room. Minutes later, the lawyer returned and told her Chernyak had died. She screamed and cried, she said, and asked to see him. She was told that because there was an ongoing investigation, she could not view his body. In his apartment, she placed his wooden urn between two vases of white roses.

“I’m 100% sure that if not for all these conditions he was in, if not for all the injustice, he would still be alive,” she said.

Her humanitarian parole expires in 2026. For now, she is working for Uber Eats. She is trying to repatriate the remains to Chernyak’s parents in Ukraine. What does she want from the U.S. government?

“I would want them to stop tormenting people,” she said. “I feel that what is happening in Ukraine and what is happening in the U.S. now, how immigrants are being treated, is just inhumane.”

Another lawyer for the family, Katie Blankenship, said they plan to file a wrongful-death claim.

“What happened to Maksym Chernyak is a fate that no one should ever suffer,” said Blankenship, who is a co-founder of Sanctuary of the South and represents multiple detainees at Krome. “Our position is that if Maksym had not been in ICE custody he would still be alive today.”

‘Dizziness and fainting spells’

In December, Genry Ruiz-Guillen, 29, was hospitalized for nearly a week with “acute psychosis,” records show.

The Herald requested medical records for Ruiz-Guillen at Krome but has yet to receive them. Attempts to reach his family for this article were unsuccessful.

But medical professionals said the autopsy, toxicology, and death reports obtained by the Herald raise questions about his treatment and subsequent death.

Ruiz-Guillen was transferred into ICE custody in October after an arrest on a domestic-battery charge. His intake shows no prior medical conditions, but his autopsy said family confirmed he had a history of schizoaffective disorder.

At Krome, he had “dizziness and fainting episodes,” seizures and confusion. He fell in his room. On at least one occasion, he appears to have lost consciousness. He was referred to a cardiologist and a neurologist, but it is unclear if he saw either, and twice went to an ER.

According to his death report, Ruiz-Guillen was transferred to nearby Larkin South Community Hospital on Dec. 9 after he “struck an officer.”

At the second hospital, Larkin Behavioral Health Hospital Services, the report says he received “psychiatric treatment.” On Jan. 8, he was transferred to Larkin Community Hospital Palm Springs for “unresolved rhabdomyolysis:” a life-threatening breakdown of muscle tissues.

“Throughout hospitalization he was described as aggressive, agitated and restless,” according to the medical examiner’s report.

His autopsy listed his cause of death as “complications of schizoaffective disorder:” a mental illness that can cause hallucinations, delusions, depression and other symptoms, but not death, experts say.

“I’m infuriated,” said Jim Recht, a psychiatrist and lecturer on psychiatry at Harvard Medical School. “Let’s say a person had schizoaffective disorder and they were agitated, and you shot them and killed them. You could say that the cause of death was complications of schizoaffective disorder.”

Recht said medical conditions are often misdiagnosed in people with serious mental illness because those conditions are falsely attributed to an individual’s behavior. The unresolved symptoms, he said, indicate that Ruiz-Guillen might have had an undiagnosed condition.

Four psychiatrists said that without hospital records showing his treatment, it is hard to know what happened. But still they raised concerns about his symptoms, the medications in his system, and what they possibly indicated. Recht said his symptoms could possibly indicate neuroleptic malignant syndrome — a possibly fatal condition induced by anti-psychotics that is often treatable. If Ruiz-Guillen had it, “he should have survived,” Recht said.

Baden pointed out that a drug found in his autopsy is commonly a street drug — and controlled in Florida: Chlorophenylpiperazine. Psychiatrists said it could be a broken-down component of an anti-depressant found in his autopsy.

Michael Ostacher, a professor of psychiatry and behavioral sciences at Stanford University, said he was surprised that Ruiz-Guillen died after a seven-week hospitalization.

“It’s very unusual for somebody to die of the complications of schizoaffective disorder while they’re in the hospital being treated for schizoaffective disorder,” he said. “I‘m concerned that the care failed to meet the standard of care expected of a reasonable medical provider.”

Paul S. Appelbaum, the former president of the American Psychiatric Association, has conducted forensic evaluations in civil and criminal cases and is now a professor of psychiatry at Columbia University. “Overcorrection of high potassium levels” — a complication listed on the autopsy — is “not a natural cause of death,” he said.

“That’s a complication of the medical treatment and a medical error as opposed to a natural cause of death,” he said.

He described Ruiz-Guillen as “a man who goes nearly three months with a set of serious symptoms and ultimately dies without a clear answer, or a clear course of treatment to address those symptoms being implemented.”

“That’s a worrisome pattern, that people who are being confined under government supervision are dying for unexplained reasons,” said Appelbaum. “At least [Ruiz-Guillen’s] death seems unexplained and raises serious questions about the treatment that he received.”

The Herald requested clarity on Ruiz-Guillen’s cause of death, the medications he was receiving, and asked if he could have had neuroleptic malignant syndrome but the hospital declined to comment. Reporters submitted Freedom of Information Act requests for medical records that are still pending.

But on one point, records are clear: Three months after Ruiz-Guillen was taken into ICE custody, he was dead.

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(Miami Herald Staff Writer Julie K. Brown contributed to this report.)

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