In July, after a Salvadoran woman who was detained by Immigration and Customs Enforcement had a medical emergency, agents took her to a Los Angeles-area hospital and waited for her in the lobby 24/7 for two whole weeks, the woman’s attorney said. Then they transferred her to another hospital, where they set up camp in her room and pressured her, she told her attorney, to say she was well enough to be discharged.
The mere presence of immigration agents at or near hospitals and clinics is creating an understandable fear.
Last year, the Department of Homeland Security rescinded the “protected areas” policy that had long restricted immigration enforcement at schools, hospitals and churches. The rescission of this policy is a clear signal from the federal government: Spaces once understood to be safe from immigration enforcement aren’t any longer.
The mere presence of immigration agents at or near hospitals and clinics across the country is creating an understandable fear among many patients, who now delay or completely avoid medical care. A KFF/New York Times survey of immigrants published in November found that “President [Donald] Trump’s increased immigration enforcement activity has contributed to resounding levels of fear and uncertainty among the immigrant community, which can negatively affect the health and well-being of immigrant families and make them more reluctant to access health coverage as well as health care.”
Regardless of their immigration status, many people are afraid. Janell Johnson Thiele, a nurse at Hennepin County Medical Center in Minneapolis, told MedPage Today that even some U.S. citizens are hesitating to seek care if they have an accent. They also worry they may be profiled based on how they look. Nor is the fear limited to patients and their families. DHS sent a subpoena on Jan. 8 to Hennepin Healthcare for its I-9 forms — which document verification of employment eligibility — and one worker told a local television station, “My co-workers have seen ICE in the building. People are afraid to come to work.”
“The American Medical Association is deeply concerned by reports of immigration enforcement activity in and around hospitals and emergency rooms — a tactic fueling fear among patients and hospital staff alike,” the nation’s largest and oldest physician organization said in a statement last week. “When people are afraid to seek medical attention for themselves or their families, it threatens their health, impedes the ability of physicians to render care, and ultimately undermines basic trust in our health care institutions.” When the profession’s leading body raises an alarm at this level, it reflects a systemic risk, not a localized discomfort.
From the Deep South — including Louisiana and Mississippi — to the Pacific Northwest, there are reports of immigrants skipping care to avoid being detained. In Portland, Ore., a nurses union has raised concerns that ICE officers are pressuring nurses and doctors to skip assessments, tests or monitoring to have detainees discharged more quickly.
A health care system cannot function safely when clinicians are afraid to come to work or are distracted by the possibility that enforcement activity could erupt in the middle of care. Fear degrades attention, judgment and trust. It increases burnout and absenteeism, and it weakens teams. Ultimately, it compromises care for all patients.
ICE enforcement in and around medical facilities is an issue that goes beyond immigration policy: It’s a social and cultural issue about the disparity of safety within public institutions and the experience of state power at the point of care. When seeking medical help carries even a perceived risk of questioning, detention or misidentification, it’s a rational response to avoid it.
For patients, the calculus is not ideological; it’s deeply practical. Many patients are considering new and very different questions before they seek care. Will showing up make me more vulnerable? Will asking for help put me at risk? If I do seek care, will my family be able to find me if I get detained? Or is this hospital using “blackout” procedures, in which it registers people in ICE custody under a pseudonym and won’t even confirm to loved ones that they’re there? When the answers feel uncertain, people wait, because waiting feels safer than exposure. Families are now weighing the need for care against the risk of separation. Waiting also makes people sicker. Skipped medications lead to complications that require hospitalization, untreated infections worsen and spread, and delayed prenatal care increases the risk of maternal and infant harm, to name just a few issues. As an emergency physician, I’ve seen the consequences of delayed care. In almost every case, issues that could have been quickly and easily addressed at a clinic become a crisis that needs emergency care. In turn, the emergency department becomes the entry point for problems that could have been addressed earlier and more safely — straining systems that are already stretched thin. Families are now weighing the need for care against the risk of separation, because even when clinicians do everything right, they cannot reliably assure safety beyond the walls of the exam room. This fear does not remain neatly contained to one population. It spreads. It reshapes behavior across communities, and it widens gaps in care for anyone perceived as out of place or at risk, regardless of their immigration status. Fear delays care, and delayed care harms patients. We’re at an inflection point where more Americans don’t know whether health care will protect them, cost them or harm them. And when hospitals stop feeling safe, the consequences are dangerous.
Uché Blackstock, M.D., is the founder and CEO of Advancing Health Equity, best-selling author of "LEGACY: A Black Physician Reckons with Racism in Medicine" and a former MSNBC and NBC News medical contributor. 
