The rollback of federal protections for hospitals as “sensitive locations” has intensified concerns about Immigration and Customs Enforcement (ICE) raids in healthcare settings and as sown fear and confusion among patients and healthcare providers. Hospitals must act swiftly to protect patient rights, maintain operational integrity, and foster trust while staying vigilant for evolving legal and policy developments. By implementing robust protocols, educating staff, and supporting vulnerable patients, healthcare institutions can navigate these challenging times while upholding their mission to care for all who seek help.
Recent Rollbacks in Security Measures
On January 20, 2025, the Department of Homeland Security (DHS) rescinded the 2021 policy that designated hospitals as protected areas where immigration enforcement was to be avoided. This means ICE can now conduct enforcement actions, including arrests, inside hospitals without special restrictions. The removal of these protections has made healthcare facilities vulnerable to unannounced ICE visits, raising the risk of patient detentions during or after receiving care.
What Hospitals Are Reporting
- Increased Patient Fear and Avoidance: Clinics in Southern California have reported a sharp rise in appointment cancellations up to a third for medical visits and half for dental appointments due to fear of immigration raids.
- Chilling Effect on Care: Hospitals are seeing declines in emergency department visits, suggesting that individuals may be delaying or forgoing necessary care out of fear of encountering ICE. This is particularly dangerous for patients with chronic conditions, who may experience worse health outcomes as a result.
- Staff Anxiety and Operational Disruption: Health workers near the U.S.-Mexico border and in other high-risk areas are anxious about the potential for ICE raids, which can disrupt patient care and erode trust in the healthcare system.
- No-Warrant Access Attempts: In some regions, ICE agents have arrived at hospitals without judicial warrants, expecting immediate access to patients or restricted areas. This can catch staff off guard and lead to over-compliance with ICE demands.
What Hospitals Should Expect
- More Frequent ICE Visits: With the rollback of “sensitive location” protections, hospitals should anticipate an increase in ICE enforcement activities, though the exact frequency remains uncertain.
- Pressure to Disclose Information: ICE agents may request access to patients or their health information. However, hospitals are generally not legally obligated to share information about a patient’s immigration status unless presented with a judicial warrant.
- Operational and Ethical Dilemmas: Hospitalists and staff will need to balance compliance with law enforcement requests against their obligations to protect patient privacy and provide unbiased care.
State Responses and Protective Measures
- Legislative Action: Some states are considering or have introduced legislation to either facilitate or restrict ICE operations in hospitals. For example, California officials have reiterated their commitment to protecting patient privacy and have expressed concern over federal data-sharing practices.
- Advocacy and Public Statements: Hospital associations and professional organizations are advocating for the reinstatement of sensitive location protections and are raising awareness about the chilling effect of ICE raids on public health.
Recommendations for Hospitals
- Establish Clear Policies: Develop and regularly update protocols for responding to law enforcement requests, including those from ICE. Ensure all staff know to refer ICE agents to a designated administrator or legal representative and not to grant access without a judicial warrant.
- Staff Training: Educate staff on patients’ rights, privacy laws (such as HIPAA), and the difference between judicial and administrative warrants. Reinforce that staff are not required to answer ICE questions or provide information without proper legal documentation.
- Protect Patient Privacy: Reiterate that there is no affirmative legal obligation to collect or report immigration status. Patient health information should only be shared as required by law.
- Communication Plans: Prepare internal communication strategies to manage information flow and minimize disruption during potential ICE encounters.
- Patient Support: Inform patients of their rights, including the right to remain silent and to decline to speak with ICE officials. Provide reassurance that the hospital’s priority is their health and safety.
- Legal and Ethical Oversight: Designate legal counsel or compliance officers to oversee interactions with ICE and ensure that any enforcement actions do not compromise patient care or violate privacy laws.
