Could immigration enforcement in hospitals spawn a public health crisis?

As evidence of hospital-based crackdowns by U.S. Immigration and Customs Enforcement mount, concern is rising that the actions could have a chilling effect on immigrants pursuing healthcare that could cause a public health crisis. Researchers writing for the Journal of American Medicine argue that hospitals must prepare protocols for dealing with ICE enforcement and should ensure that immigrants have a safe place to seek care without fear of interrogation, arrest or deportation.

Physician authors Altaf Saadi, Sameer Ahmed and Mitchell Katz, who will soon take the helm of New York City Health+Hospitals, recounted a reported incident in July in which a distraught father at his comatose son's bedside at a San Antonio hospital was accosted by ICE agents when they entered his son's hospital room and began "aggressively" questioning him. The man was an undocumented immigrant, and his son was in the hospital after being found in a parked, unventilated trailer.

Another incident authors cataloged occurred in February, when a 26-year-old undocumented immigrant named Sara Beltran-Hernandez was bound by her hands and feet and then removed in a wheelchair from a Fort Worth Hospital by ICE agents as she awaited brain surgery. In another incident, in June, a 37-year-old man on the way to pick up his newborn son following surgery for pyloric stenosis at a Boston hospital was arrested by ICE agents. Other undocumented workers injured on the job have been arrested at doctor's appointments and after filing worker's compensation claims, the authors said.

[Also: California lawmakers scramble for legislation ensuring coverage for illegal immigrants]

These types of occurrences are stoking fears for undocumented immigrants that they are not safe going to hospitals or other medical facilities. Under other previous administrations, even ICE recognized hospitals as sensitive locations, like schools and churches, where enforcement action shouldn't be executed except where "exigent circumstances" are present.

Poverty and social determinants of health are already dissuading some from seeking care, but now the fear of deportation has been added to the list barriers. The 2010 Arizona law that allowed local police officers to check anyone's immigration status simply where suspicion of illegal status existed spurned research that showed Hispanic mothers were less likely to seek care, even primary care, for themselves and their children regardless of their status. A study by the Los Angeles Police Department even documented a drop from 2016 to 2017 in the reporting of sexual assault among the city's latino population, authors wrote.

Therefore, the authors argued that medical professionals need to support undocumented immigrants and push for hospitals to be regarded as "sanctuary" spaces. Some hospital practices already speak to such a mindset, such as some hospitals declining to ask about immigration status during intake, and HIPAA protects patient medical records and sensitive information except in highly limited circumstances.

Still, the authors said hospitals and staff must do more. For one, having clearly defined policies and procedures regarding encounters with immigration officers is crucial, and so is training your staff accordingly. "If ICE agents come to the hospital, for example, their identification should be verified, and absent an emergency such as to avoid immediate harm or criminal activity, no hospital employee should provide information about any patient to the agents or provide them access to any patient's room without a court-ordered warrant or subpoena."

Hospitals could also inform patients that their personal information will not be shared with ICE through awareness campaigns, and take extra precautions before cooperating with ICE, whether their stated objective involves investigation of or actions against patients or not.

The authors used Mission Hospital in Mission Viejo, California as an an example. They have refused to join ICE's Critical Infrastructure Outreach Program, a program that seeks to build partnerships with local organizations like hospitals and medical clinics to help the agents "develop potential sources of information" because hospital leadership didn't want to give the impression to patients and the community, especially immigrants, that "the hospital was not a safe space 'where all are welcome who have a medical need to seek care … without any fear or hesitation.'"

The authors invoked the widely-felt sentiment in their profession that medicine is a higher calling that carries with it an inherent commitment to serve the underserved, protect the less fortunate and provide care regardless of their ability to pay or status.

"These ideals are being challenged in health care settings and other places that should be safe from politics, and it is important that healthcare professionals speak with a single voice to fulfill their ethical responsibilities," authors wrote.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com