Healthcare workers in California have raised concerns about protocols for handling an increased presence of Immigrations and Customs Enforcement agents in medical facilities, Cal Matters reported Aug. 26.
The appearance of federal immigration agents have become more routine since President Donald Trump’s administration ramped-up its efforts to detain and deport individuals illegally residing in the U.S.
Recent incidents spark concerns
In July, agents arrested a man inside a California ASC in what quickly escalated to a heated encounter captured in a cellphone video. ICE agents and contractors also “camped out” out the waiting room of Glendale (Calif.) Memorial Hospital for 15 days, allegedly waiting to detain a woman being treated inside the hospital for a serious medical condition, the Los Angeles Public Press reported July 9. Nurses and patient advocates told the publication that the extended presence of the agents created an “intimidating” and “hostile” environment that interfered with patient care.
“This is nothing new to hospitals,” Lois Richardson, vice president and counsel at the California Hospital Association, told Cal Matters. “We get inmates, detainees, arrestees all the time, whether it’s police, sheriff, highway patrol, ICE, whatever it is.” She added that hospital workers should remain focused on providing care, and advised against getting involved with disputes over why a person is in custody.
However, healthcare workers, advocates and immigration attorneys still expressed concerns over the management of these cases, specifically with regard to the application of protocols like visitation rules, threats to patients’ legal and privacy rights, and risks to healthcare workers themselves.
“We have a level of privacy that we owe to patients and their families, and that has just been completely demolished with all of the involvement of ICE coming into hospitals,” Kate Mobeen, RN, an ICU nurse at John Muir Medical Center in Concord, Calif., told Cal Matters. “It creates just a huge sense of fear, not only in our patient population, but in our employee population and our nurses.”
John Muir Medical Center was the site of another recent ICE incident, according to the report. On July 29, ICE agents took a man to the hospital due to an unspecified medical emergency while being detained outside local immigration court. The man’s attorney, Ali Saidi, told the publication that when he arrived at the hospital, he was told he could not see the detained patient, but that the man’s family would be allowed. When the man’s wife arrived, she was then told there would be no family visits allowed.
The wife, identified in the report by her middle name, Maria, said that hospital staff would also not give her or other family members any information about her husband. John Muir officials did not provide comment to Cal Matters, citing privacy concerns, but said that general policy states “If a law enforcement agency indicates that visitation presents a safety or security concern, [the hospital] may limit or deny visitation to protect our patients, staff and visitors.”
Mr. Saidi said that when Maria insisted on getting information about her husband’s condition, hospital security called the police. Hospital officials claimed that law enforcement is only called when a patient or visitor’s behavior becomes “abusive, disruptive or threatening,” but Mr. Saidi denied that Maria or her family displayed any of these behaviors.
Mr. Saidi told Cal Matters that the environment in the emergency bay was unlike anything he had seen before, and that staff was visibly uncomfortable. Multiple ER nurses told Ms. Mobeen, also a leader with the California Nurses Association, that ICE agents were “very aggressive with staff,” leaving them “emotionally and physically upset” following the incident.
Ms. Mobeen said that part of the issue is that staff were not given adequate training on how to respond to any kind of immigration enforcement action that may occur at the hospital. Ben Drew, the spokesman for the hospital, countered that hospital staff were given guidance on its longstanding law enforcement policy and have answered numerous questions about what to do if ICE showed up at the hospital since Mr. Trump took office in January.
A sometimes gray legal area
After ICE agents spent two weeks camped out at Glendale Memorial Hospital, officials responded in a statement that they could not legally prohibit law enforcement from being in public areas.
Legal experts agree with this statement, Cal Matters reported, but agents cannot move through hospitals without limits. Law enforcement officials are also not permitted to search for people in exam rooms or other private spaces without a signed federal judicial warrant.
This becomes more of a legal gray area when agents bring in someone who is in their custody and needs medical care. Ms. Richardson told the publication that how far an agent can go into treatment areas with a detained patient may be decided on a case-by-case basis. In cases where a detained patient is struggling or resisting, that patient may need guarding.
If agents enter exam rooms, they may hear medical information — but this may not violate federal privacy laws. There is a provision of HIPAA that allows for “incidental disclosures” of information as long as “reasonable safeguards” are applied, creating a subjective standard for disclosures of private medical information.
“The hospital will, and the doctor will make reasonable attempts to protect the patient’s privacy,” Ms. Richardson said. “What is reasonable is going to depend, again, on what’s wrong with the patient, how the patient is behaving, the nature of the circumstances.”
HIPAA specifically prohibits the disclosure of medical records, which include names, addresses, and social security numbers along with health conditions. State law requires health facilities to protect this information. Health facilities should also consider immigration status as confidential information, according to the California attorney general’s office.
However, some disclosures are required if law enforcement can prove lawful custody or present a federal judicial warrant signed by a judge. In this case, ICE agents may access certain information or search a particular area —- but these permissions are not immediately granted by an ICE administrative warrant.
A desire for enhanced training
Healthcare workers in California told Cal Matters that they’d like to receive additional guidance on how to respond to these incidents in their workplace.
Adriana Rugeles-Ortiz, a licensed vocational nurse at Kaiser Permanente Modesto (Calif.) Medical Center, has been leading “know your rights” sessions at her hospital through her union, SEIU-United Healthcare Workers West.
“Because of my involvement with all the training that we have done to the workers and to the community, personally, I do feel prepared. I am not that confident that we have been able to reach the entire workforce within Kaiser to get them to the level of confidence to deal with it,” Ms. Rugeles-Ortiz said.
Douglas Yoshia, MD, an emergency medicine physician at Stanford Health Tri-Valley in Pleasanton, Calif., said that the hospital is located near the county’s Santa Rita Jail, and that staff have been used to law enforcement presence. However, the recent incidents at John Muir and Ontario (Calif.) Surgery Center, which resulted in criminal charges being filed against two employees, have created a higher level of tension at his facility.
“Normally, health care workers have no reason to fear law enforcement,” he told Cal Matters, “but we’re in uncharted territory.”
