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U.S. Immigration Enforcement Practices Violate Patient Rights and Medical Ethics

Physicians for Human Rights documents discrimination leading to egregious health care violations, including impeding patient care and neglect of medical advice

As the humanitarian crisis grows along the southern border of the United States, a policy brief from Physicians for Human Rights (PHR) shows that harsh and discriminatory immigration enforcement actions within the militarized border zone are violating patient rights and creating widening racial and ethnic health disparities. U.S. and international laws protect the right of all individuals to non-discriminatory access to emergency health care, but U.S. immigration enforcement officials’ aggressive, arbitrary actions are putting the health care of patients and the ethical obligations of medical professionals at risk.

PHR’s issue brief, “Not in My Exam Room: How U.S. Immigration Enforcement Is Obstructing Medical Care,” documents violations of patient rights, including cases in which medical advice was ignored by U.S. immigration enforcement officials and patients’ treatment was impeded by arrest or detention. As part of an effort to identify the key features of enforcement actions impeding access to quality medical care, PHR conducted interviews with health professionals in the border communities of Brownsville, Houston, Los Angeles and Tucson, as well as other cities across the United States, between June and September 2018.

“The disruption of medical care by U.S. immigration enforcement officers is deterring some patients from seeking medical care out of fear of coming in contact with immigration officials, thereby putting their health at risk,” said Kathryn Hampton, network program officer at PHR. “It is the ethical imperative of medical professionals to treat patients according to evidence-based medical practice. Patients have the right to be treated by a physician who is free to make decisions about ethical clinical treatment without outside interference. We must make sure that medical facilities adopt policies that protect both physicians and patients in situations that threaten those ethical commitments.”

PHR’s interviews found instances of immigration officers detaining patients undergoing treatment in hospitals, refusing to unshackle critically ill patients during medical exams, holding occupied ambulances at checkpoints, and arresting patients directly before surgery. In some cases, patient confidentiality was violated by immigration officials’ insistence on remaining present during medical evaluations. These enforcement actions not only violate fundamental U.S. and international laws, but also force physicians to compromise their ethical obligations to patient care and privacy.

While medical ethics assume that hospitals are and should be safe spaces, the PHR brief encourages the establishment of “sanctuary hospital” practices, which ensure the uniform protection of patients’ rights. PHR’s interviews indicate that more robust measures are needed to protect patients and medical professionals, including directing staff on how to interact with immigration agents, explaining how to approach immigration issues with patients, noting the best way to record relevant patient information, and clarifying obligations under the Health Insurance Portability and Accountability Act as pertaining to immigrant patients.

Among the health professionals who spoke with PHR, many cited concerns about U.S. officials’ violations of the Sensitive Locations policy, an Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) policy that protects medical facilities from enforcement operations except in cases of “exigent circumstances” or prior supervisory approval. Despite the existence of this policy, instances of ICE and CBP agents targeting patients and their family members for enforcement during delivery of care raises serious concerns. Such violations hinder medical professionals from doing their jobs and from providing non-discriminatory care.

The Sensitive Locations policy offers more limited protections to patients and providers in border states, but instances cited in the brief raise doubts about ICE and CBP compliance with the policy. CBP officials arrested Rosa Maria Hernandez, a 10-year-old suffering from cerebral palsy who was in need of emergency gallbladder surgery, while she was being transferred by ambulance between two hospitals. Following her arrest, CBP officials ignored medical advice that Rosa be safely discharged back to her family. She was instead transported to a juvenile detention facility directly after discharge.

Informed by field consultations, PHR offers a number of recommendations to medical staff and health facilities, as well as to medical associations. The brief advises elected officials to support the adoption of legislation that codifies the Sensitive Locations policy into the Immigration and Nationality Act; exercise their oversight of Department of Homeland Security (DHS) agencies to ensure compliance with the policy; and support the adoption of state and local policies which protect access to medical attention for noncitizens.

Lastly, PHR calls for the DHS to provide training for CBP and ICE agents to understand medical ethics and consider the medical needs of patients affected by enforcement actions; to investigate and sanction agents who violate guidelines; to publicize those investigations to ensure respect of the Sensitive Locations policy by all agents; and to consult with independent medical providers both to develop policies and guidelines and to evaluate the health consequences of policies and practices.

Additional PHR resources:

  • Fact Sheet: “Establishing Sanctuary Hospitals: Protecting the Right to Access Health Care,” June 10, 2019
  • Blog Post: “Choosing Between Death and Deportation: The Need for Sanctuary Medical Facilities,” June 10, 2019
  • Press Release: “U.S. Administration Is Neglecting the Real Emergency at the Border,” February 15, 2019
  • Policy Brief: “Zero Protection: How U.S. Border Enforcement Harms Migrant Safety and Health,” January 10, 2019
  • Blog Post: “ICE in the ER: How U.S. Policies are Causing an Immigrant Health Crisis,” December 7, 2018

Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.

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