Healing, Not Politics

By Adam Dougherty, MD, MPH

The recent Department of Homeland Security rescission of immigration enforcement protections in or near “sensitive areas,” notably hospitals and clinics, has already caused confusion and misinformation for our physicians and threatens the sacred physician-patient relationship. Hospitals, clinics, and doctors’ offices — places where people seek healing — should not be battlegrounds for immigration politics.

The action forced our region’s health care ecosystem to take stock of relevant policies and procedures. Fortunately, ample resources have emerged for individual providers, medical groups, and health systems who may face Immigration and Customs Enforcement or Customs and Border Patrol personnel.

State attorneys and lawmakers are already proactively issuing guidance and offering new legislation to protect health care facilities. The California Office of the Attorney General recently published Promoting Safe and Secure Access for All, an updated guide to assist California health care facilities in complying with California law and to equip personnel with the information and resources necessary to continue to provide health care to all California residents. AB 421, recently introduced by Assemblymember Jose Solache Jr., would generally restrict local police and sheriff’s deputies from helping immigration authorities near medical offices. Many more local and state efforts are underway.

Our colleagues at the Alameda-Contra Costa Medical Association went a step further and compiled an excellent guidance to assist members in understanding how immigration actions may intersect with clinical practice considerations so that physicians and their teams can make informed choices that minimize harm to patients. This is not considered legal advice. Some of the recommendations (and additional resources within the guide) include:

• Consider enhancing and expanding facility “restricted areas,” because designated public areas are free to entry for any law enforcement official without a warrant.
• Consult legal counsel to review the validity of any legal order or warrant, and refuse questioning or consent for a warrantless search.
• Limit the documentation of legal status in your medical record, while still clinically acknowledging it as a social determinant of health.
• Prepare your staff and inform your patients of their (and their loved ones’) rights.

Wearing my hat of optimism, perhaps broader immigration resources through executive action can lead to significant reductions in social scorns such as human trafficking and the importation of fentanyl, which would have a major impact on the Sacramento region and its vulnerable populations.

But to be clear, the downstream consequences of the current federal government overreach are potentially devastating. If patients fear that presenting to the hospital or clinic could lead to their arrest — or the arrest of their loved ones — they simply won’t come. They won’t seek prenatal care and they won’t get vaccinated. They won’t seek mental health care. They won’t call 911 in a true emergency.

We cannot stand idly by, and we will continue to be the apolitical voice of reason. We must tell our patient’s stories and continue to be advocates and vocal leaders in our communities. And most importantly, we must lead by example and assure our patients that the exam table is an irrevocable place of healing.