A recent episode of HBO\u2019s \u201cThe Pitt\u201d portrayed the chilling effects of immigration enforcement in healthcare. Immigration and Customs Enforcement agents dressed in tactical gear and face coverings brought in a woman in zip ties to the emergency room for medical clearance. Chaos ensued: Staff were confused about how to care for the patient, both staff and patients left the hospital out of fear of being targeted and there were violent confrontations between the ICE agents and staff. Although fiction, the episode illustrated the realities of what has been happening in hospitals across California, where our healthcare, well-being and working conditions are threatened by the presence of ICE.<\/p>\n
As resident physicians in the state, we have lived similar stories. In a real-world California hospital, one resident was forced to discharge a patient with poorly controlled diabetes back into ICE custody. Because of the detention center\u2019s medical neglect, the patient\u2019s blood sugar had risen to a level requiring ICU care. He was stabilized in the hospital only to be sent back to the very facility where he fell in danger. When hospitals send patients back to the same conditions of neglect, there is no long-term plan, only a deferment in their next medical crisis.<\/p>\n
Medical neglect in immigration detention facilities is widely documented<\/a>. Patients in ICE centers are often denied adequate food, drinkable water, clean clothing and medications. Their access to medical care is often delayed, when not outright denied. If and when patients in ICE custody are brought to the hospital, the presence of immigration enforcement makes it difficult for these patients to get the care and services they need.<\/p>\n Hospitals bear responsibility for this. Rather than establishing clear policies to protect patients and staff, hospitals have largely complied and cooperated with immigration enforcement. ICE agents have refused to leave the room during private medical interviews<\/a>, charged <\/a>workers with felony assault after they intervened to protect a patient, forbidden providers from calling patients\u2019 families and legal representation or required that patients use pseudonyms<\/a> that effectively hide their whereabouts from family. A state law passed last year requires hospitals to protect patient privacy from ICE, yet implementation has been inconsistent<\/a> across hospitals. When hospitals go along with harmful policies and decisions, they normalize harm.<\/p>\n At one Northern California hospital, resident doctors asking about ICE protocols were told their institution hoped to \u201cfly under the radar of the Trump administration\u201d by acquiescing to ICE demands. Formally, University of California facilities instruct<\/a> residents to treat ICE detainees as \u201cindividuals under law enforcement custody,\u201d despite the fact that immigration detention is civil, not criminal. UC risk management has also instructed resident physicians not to help connect patients to a lawyer, but instead to give \u201cknow your rights\u201d fliers and hotline information to patients \u2014 who often do not have access to phones.<\/p>\n Hospitals are meant to be sanctuaries that promote healing. Yet, immigration enforcement has infiltrated clinical spaces and degraded trust at the bedside. Trust is not inconsequential in medicine; it is fundamental to whether patients seek care, relay critical information, take medications and even survive their illness. As providers, many of us are unsure whether we are allowed to connect our patients with legal services or even insurance coverage, such as Medicaid. These concerns aren\u2019t unfounded: ICE has camped out at hospitals<\/a> to apprehend patients and has used access<\/a> to information within Medicaid records to deport<\/a> patients. These should be illegal transgressions of patient privacy, but currently, they are not<\/a>.<\/p>\n As doctors, we have a vantage point that allows us to witness firsthand the harmful and, at times, deadly consequences of immigration enforcement in our clinical spaces. The Hippocratic oath we take demands first and foremost that we do no harm. Yet hospitals are increasingly subordinating this oath to institutional self-interest. This is an immoral path, and as physicians on the front lines of patient care, we refuse to accept it.<\/p>\n Thanks to resident and community advocacy, Los Angeles County implemented a policy<\/a> this month to protect patients in ICE custody who come into county hospitals. Other hospitals must follow suit. Hospital leadership should stand with staff and patients, not with ICE. All hospitals must articulate clear, standardized protocols for ICE encounters, ensure front-line workers are trained to protect patient privacy and be held accountable when they fall short of the California law meant to shield patients from ICE.<\/p>\n All of us can do our part as well: Residents can organize with our union, CIR\/SEIU<\/a>, or with organizations such as the People\u2019s Care Collective<\/a>. Community members can contact state representatives to demand enforcement of last year\u2019s Senate Bill 81<\/a>, report noncompliant hospitals to the California Department of Public Health<\/a> and the attorney general\u2019s office<\/a> and support legal organizations such as the Coalition for Humane Immigrant Rights<\/a>.<\/p>\n Hospitals exist to heal, not to function as arms of immigration enforcement. When hospitals blur that line, they don\u2019t just erode the ethical mandates of medicine: They choose complicity and harm over care. Hospitals should choose courage instead and join healthcare providers in honoring our oath \u2014 to stand with patients, not ICE.<\/p>\n Alana Slavin is a psychiatry fellow in Los Angeles. Marina Martinez is an internal medicine resident physician in San Francisco, where Sascha Bercovitch is a psychiatry resident physician.<\/p>\n Insights <\/p>\n L.A. Times Insights<\/a> delivers AI-generated analysis on Voices content to offer all points of view. Insights does not appear on any news articles. <\/p>\n Viewpoint This article generally aligns with a Center Left<\/b> point of view. Learn more about this AI-generated analysis<\/a> Perspectives <\/p>\n The following AI-generated content is powered by Perplexity. The Los Angeles Times editorial staff does not create or edit the content.<\/p>\n Ideas expressed in the piece<\/p>\n The article contends that emergency rooms should not be sites of immigration enforcement, as the presence of Immigration and Customs Enforcement agents in healthcare settings creates a \u201cchilling effect\u201d that prevents patients and healthcare workers from seeking or providing care[3]<\/a>. The piece argues that when ICE agents appear in hospitals, staff and patients flee out of fear, undermining the functioning of healthcare facilities even among those with legal status[2]<\/a>.<\/p>\n<\/li>\n The authors emphasize that medical neglect in immigration detention facilities is well-documented, with patients often denied adequate food, water, clean clothing and medications. The article illustrates how hospitals that discharge patients back to ICE custody without proper medical planning only defer their next medical crisis, as one resident physician was forced to discharge a diabetic patient to detention where neglect worsened his condition[1]<\/a>.<\/p>\n<\/li>\n The article maintains that hospitals bear institutional responsibility for complying with immigration enforcement rather than establishing clear protective policies. The authors argue that ICE agents have violated patient privacy by refusing to leave rooms during private medical interviews, forbidding providers from contacting families and legal representation, and preventing patients from accessing phones[1]<\/a>.<\/p>\n<\/li>\n The piece contends that hospitals\u2019 cooperation with immigration enforcement undermines the fundamental principle of medicine: doing no harm. The authors argue that when hospitals prioritize institutional self-interest over patient welfare, they betray the Hippocratic oath and erode trust at the bedside, which is essential to whether patients seek care, relay critical information and survive illness[1]<\/a>.<\/p>\n<\/li>\n The article calls for hospitals to implement clear, standardized protocols for ICE encounters, ensure staff are trained to protect patient privacy, and enforce California\u2019s Senate Bill 81, which requires hospitals to protect patient privacy from federal agents[1]<\/a>.<\/p>\n<\/li>\n<\/ul>\n Different views on the topic<\/p>\n The search results provided do not contain substantive expressed perspectives opposing the article\u2019s position on ICE enforcement in healthcare settings.<\/p>\n \n