Detained at the doctor’s office: US immigration policy endangers health

On 20 January 2025, the day of his second inauguration as president, Donald Trump signed an executive order rescinding the Biden era policy that restricted Immigration and Customs Enforcement (ICE) operations at “sensitive” locations, including schools, churches, and healthcare facilities.12 The negative impact has been immediate. Patients are fearful, public health is under threat, and providers are braced for ethical challenges.

One author (KRP) is the medical director of a charitable programme that provides access to healthcare for people on low incomes excluded from coverage under the Affordable Care Act—primarily immigrants. Another author (CNC) directs an organisation that provides comprehensive primary care, mental health, and medicolegal services for asylum seekers and other forced migrants. We immediately heard from concerned patients, wondering whether it was safe to come to the clinic, asking to switch to telehealth appointments, and questioning whether they should disenroll their children (in many cases US citizens) from public benefits. Providers were alarmed too, seeking guidance on institutional protocols if ICE were to show up at the hospital.

This executive order is one of several aggressive actions targeting immigrants announced by the new administration. These actions include the use of military resources to accelerate deportations, the transfer of detained immigrants to Guantánamo Bay, and an executive order attempting to revoke birthright citizenship.345 Together, these measures seem to be the first steps towards Trump’s central campaign promise to deport millions of immigrants living in the US.6

Although the full extent of these policies on public health remains unknown, the experiences from the first Trump administration offer a sobering warning. The covid-19 pandemic unfolded during a time of hostile anti-immigrant actions and policies, including family separations, enhanced workplace raids, and the implementation of the “public charge” rule, which counted the use of certain public benefits against applications for permanent residency.

Even before the first cases of covid-19 were detected in the US, numerous studies documented the “chilling effect” these policies had on healthcare utilisation by immigrants. This included declines in emergency department visits, preventive care, and enrolment in Medicaid and food assistance programmes.78910 Although the Trump administration paused the public charge rule early in the pandemic, reversing years of fear and distrust proved impossible.11 Institutional mistrust became a key driver of the disproportionate covid-19 mortality among immigrant communities, particularly those living on low incomes and without legal status.12

Among healthcare providers, there is a deep sense of unease. Trust is the foundation of the patient-provider relationship. Those of us who routinely care for immigrants know that people without authorisation to reside in the US take a leap of faith when they share their personal and often traumatic histories with us. It deeply concerns us that our past reassurances about the safety of our clinics and the confidentiality of their health information may no longer hold true. While the Health Insurance Portability and Accountability Act of 1996 protects patient data, shifting interpretations—especially regarding law enforcement access—could erode these safeguards.13 The idea that we could be forced to watch helplessly as one of our patients is detained in front of us, possibly as a direct consequence of attending a visit we scheduled for them, is unconscionable.

So, what can we do to protect patients, safeguard public health, and mitigate the moral injury to providers?

At an institutional level, establishing clear protocols and communication is paramount. Research shows that implementing welcoming, immigrant sensitive messaging and workflows can counteract the chilling effect of anti-immigrant policies on healthcare utilisation.14 Clearly designating private and public spaces within healthcare facilities protects private areas—such as clinical spaces and offices—from immigration enforcement in the absence of a lawful judicial warrant. Notably, Department of Homeland Security immigration orders—often misleadingly referred to as “warrants” by ICE officers—are not issued by a judge and do not grant constitutional authority to enter private spaces.

Providers can help create safer spaces in several ways: wearing symbols of solidarity with immigrants such as monarch butterfly pins, calling and offering flexible telehealth options for patients who are hesitant to come in, providing “Know Your Rights” resources, and avoiding noting sensitive immigration related information in medical records. For patients with comorbidities, anticipatory documentation of their medical needs, provided in print form to the patient, may be helpful to mitigate disruption to essential treatments in the event of unexpected detainment.

Beyond direct patient care, health providers and researchers must document the harm of these policies on health outcomes. Quantitative research can track changes in healthcare utilisation, vaccination rates, diagnostic delays, and physiological stress markers. Qualitative research, meanwhile, can capture the lived experiences of people affected, providing critical context for advocacy.

We can ask our patients, “How are you, really?” Some may not want to talk about it, but in our experience, many will. Although we may feel powerless, the simple act of listening can be profound.

Finally, let’s not forget to check in and support our fellow health providers as we navigate this uncertain moment. The strain of working in a system that contradicts our fundamental oath to “do no harm” is real. Acknowledging it, together, is the first step toward resisting it.