Hospitals and emergency departments have long been considered places of refuge, where individuals can access medical care without fear of discrimination or interference, regardless of their immigration status.
However, recent changes in immigration enforcement policies, including the recission of 2011 Sensitive Locations Memorandum, have heightened concerns about how health care providers should respond to Immigration and Customs Enforcement (ICE) agents visiting hospitals. This shift has significant implications for patients, clinicians, and hospital operations, especially in emergency settings where patient trust and safety are paramount.
- Click here for a printable flyer offering guidance on interacting with ICE in the ED.
- Click here for a sample institutional policy.
Background
Historically, ICE was discouraged from conducting enforcement actions—such as arrests or interrogations—in certain locations, including hospitals, schools, and places of worship.1 The intent of this policy was to ensure individuals could access essential services without fear of deportation. However, recent policy changes have diminished these protections, permitting ICE to conduct enforcement actions in hospitals under certain conditions. This policy shift has raised alarm within the medical community, particularly in emergency departments where vulnerable populations frequently seek care.
This shift could deter undocumented individuals from seeking medical care, placing healthcare providers in the challenging position of balancing legal compliance with their ethical duty to care for all patients. EDs must adopt detailed protocols and training to ensure patient privacy and safety while adhering to federal laws such as the Health Insurance Portability and Accountability Act (HIPAA).²,³
To navigate these changes, ED staff must be prepared with clear protocols and thorough training to manage ICE interactions. This article combines a comprehensive hospital policy with step-by-step instructions to equip ED staff with the knowledge and tools necessary to handle ICE interactions effectively and ethically.
The Impact on Patients and Emergency Care
Patient Fear and Avoidance of Care
Undocumented individuals may delay or avoid seeking medical care due to fear of deportation or detention. Studies show that increased ICE activity near sensitive locations correlates with decreased healthcare utilization among immigrant communities.⁴ This avoidance can lead to worsening health conditions, delays in treatment, increased emergency department visits for preventable issues, and public health risks.
Disruption of Emergency Services
ICE activity in emergency settings can create chaos, disrupt patient care, and increase stress for both patients and staff. The presence of law enforcement agents may escalate tensions, particularly for vulnerable populations already experiencing trauma.³
Ethical and Legal Considerations
Health care teams have an ethical obligation to treat all patients equitably, regardless of their immigration status.⁵ Simultaneously, HIPAA mandates the protection of patient information and limits when and how it can be disclosed, even to law enforcement.²
Detailed Step-by-Step Guide for ED Staff
Understand Legal Protections and Responsibilities
- All staff must understand that patient information, including immigration status, is protected under HIPAA. Information can only be disclosed with patient consent or a valid court order.
- Train staff to differentiate between a judicial warrant (signed by a judge and legally binding) and an administrative warrant (issued by ICE and not sufficient for access).²
- Train staff on how to handle ICE interactions respectfully and lawfully.³
- Patients have the right to decline speaking with ICE agents and may request legal representation before interacting with them.
Prepare a Response Plan
- Assign a Point of Contact (POC) to manage ICE inquiries and coordinate staff responses.⁶
- Develop clear protocols for documenting ICE interactions and preserving patient confidentiality.
Address ICE Agents Professionally
- Greet ICE agents professionally and ask for identification and the purpose of their visit.
- Request a judicial warrant to confirm the legal basis for their actions. If ICE agents present an administrative warrant, explain that it does not authorize access.³
- Direct ICE agents to a non-patient area and ensure they are accompanied by authorized personnel at all times.
- Avoid confrontations or escalating tensions.
Focus on Patient Safety
- Shield patients from ICE activity as much as possible.
- Ensure patient care continues uninterrupted.
- Do not disclose any patient information, including location or medical records, without a valid judicial warrant.²
- Focus medical records on clinical care only. Avoid noting immigration status unless it is medically relevant.
Advocate for Patients
- If ICE requests to detain or speak with a patient, inform the patient of their rights to refuse to speak with ICE agents and provide support if they wish to contact legal counsel.⁷
- If the patient is critically ill or in an unstable condition, explain that medical care takes precedence over enforcement actions.
- Offer contact information for local immigration legal aid organizations or advocacy groups.
- Reassure patients and families that the hospital is committed to providing care regardless of immigration status.
Document the Incident
- Record key details, including: names and badge numbers of ICE agents; time, date, and purpose of the visit; copies or descriptions of any warrants or documents presented; actions taken by staff.
- Submit an internal incident report to hospital administration and legal counsel.
Conduct Post-Incident Review
- Debrief staff and review actions taken during the incident.
- Update policies and training materials as needed to address any identified gaps.
WHY THIS MATTERS
The presence of ICE agents in emergency departments can erode trust in healthcare systems, especially among immigrant populations. Patients may avoid seeking care, leading to worsened health outcomes and further disparities. By implementing clear protocols and maintaining a commitment to equitable care, healthcare providers can protect vulnerable patients while navigating this complex legal landscape.
References
- Immigration and Customs Enforcement. Sensitive locations FAQs. ICE.gov. Updated October 27, 2011. Accessed January 24, 2025. https://www.ice.gov/doclib/ero-outreach/pdf/10029.2-policy.pdf
- Department of Health and Human Services. HIPAA Privacy Rule and disclosures for law enforcement purposes. HHS.gov. Updated July 26, 2013. Accessed January 24, 2025. https://www.hhs.gov/hipaa/for-professionals/faq/disclosures-for-law-enforcement-purposes/index.html
- American Hospital Association. Guidelines for releasing patient information to law enforcement. AHA.org. Published March 8, 2018. Accessed January 24, 2025. https://www.aha.org/standardsguidelines/2018-03-08-guidelines-releasing-patient-information-law-enforcement
- Barajas JM, Roemer M, Peña J, et al. Barriers to health care for undocumented immigrants in the United States. J Immigr Minor Health. 2020;22(5):1096-1104. doi:10.1007/s10903-020-01010-9
- American College of Emergency Physicians. Code of ethics for emergency physicians. ACEP.org. Accessed January 24, 2025. https://www.acep.org/globalassets/new-pdfs/policy-statements/code-of-ethics.pdf
- Hellinger FJ. When ICE shows up at your clinic or hospital. MGMA.com. Accessed January 24, 2025. https://www.mgma.com/articles/when-ice-shows-up-at-your-clinic-or-hospital
- National Immigration Law Center. Know your rights: What to do if ICE comes to your workplace. NILC.org. Accessed January 24, 2025. https://www.nilc.org/issues/immigration-enforcement/workplace-raids/