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Federal immigration agents are more routinely showing up at California medical facilities as the Trump administration ramps up deportations.

They may come to the emergency room, bringing in someone who’s suffering a medical crisis while being detained. They may wait in the lobby, as agents did for two weeks at an L.A.-area hospital waiting for a woman to be discharged. Or they may even chase people inside, as federal agents did at a Southern California surgical center.

The sight of these agents — often armed and with covered faces — makes many wary and may keep people from seeking care.

Existing hospital policies guide operations when law enforcement brings in a person under arrest, hospital officials say.

“This is nothing new to hospitals,” said Lois Richardson, vice president and counsel at the California Hospital Association. “We get inmates, detainees, arrestees all the time, whether it’s police, sheriff, highway patrol, ICE, whatever it is.” The job for hospital workers remains to provide care, she added, and not to get involved in disputes over why a person is in custody.

Yet immigration attorneys, advocates and health workers have expressed concerns over the handling of some of these cases, both by immigration officers and by some administrators at medical facilities.

Specifically, they’re worried about the application of protocols like visitation rules, about threats to patients’ legal and privacy rights, and about risks to hospital 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,” said Kate Mobeen, an ICU nurse at John Muir Medical Center in Concord. “It creates just a huge sense of fear, not only in our patient population, but in our employee population and our nurses.”

Patients’ Rights, Policies Face New Tests

Sometimes when ICE has shown up at medical facilities with a detained patient, the result has been conflicting messaging about the rules.

On July 29, ICE agents took a man to John Muir Medical Center in Concord because he suffered an unspecified medical emergency while being detained outside the Concord immigration court, according to Ali Saidi, an attorney and the director of Stand Together Contra Costa, a local rapid response and legal services organization.

When Saidi arrived at the hospital as part of the response network, he said hospital staff told him that he was not allowed to see the detained patient, but that the man’s family would be allowed. Then, when the man’s wife arrived, “The rules had somehow changed, and they said no family visit,” Saidi said.

In a statement shared by the Contra Costa Immigrants Rights Alliance, the detained man’s wife, who asked to be identified only by her middle name, Maria, said that when she later talked to her husband, he told her that he was so terrified that he passed out.

“My family and I went to the emergency room and we asked to see him and talk to him to make sure he was okay,” Maria said, in the statement. “The hospital staff would not let us see him and they would not give us any information about what was happening to him. They wouldn’t even answer my questions.”

John Muir officials would not comment on the incident, citing privacy laws. But in an email, Ben Drew, a spokesperson for the hospital, said general policy is that “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.”

Saidi said that when the wife insisted on getting information about the man’s condition, hospital security called the police.

“We understand that emotions are high whenever a family member or friend is in the emergency department or hospital,” said Drew. “The hospital only involves local police in circumstances when a patient or visitor’s behavior becomes abusive, disruptive, or threatening, and cannot be resolved through our own security team.”

Saidi denied that the family was being disruptive, saying that conversations with hospital staff and administration were respectful and no voices were raised.

“The atmosphere in that emergency bay was something like I’ve never seen before in my career,” Saidi said. “There was a chilling effect. Everyone was averting their eyes. You could tell the staff felt bad.”

Multiple emergency department nurses told Mobeen, a local California Nurses Association leader at John Muir, that ICE officers were “very aggressive with staff” and staff were afterwards “emotionally and physically upset” by what happened, she said.

“It’s horrifying to not be able to tell patients’ family members how they are, what their status is,” Mobeen said.

Part of the issue, Mobeen added, is training. Staff were not given adequate training on how to respond to any kind of immigration enforcement action that may occur at the hospital, she said.

Drew, the spokesman for John Muir, countered that the hospital has given guidance on its longstanding law enforcement policy and answered multiple questions since January about what to do if ICE agents show up at their facilities.

Limits for ICE Access Are Sometimes Murky

Last month, immigration agents occupied the lobby of Dignity Health’s Glendale Memorial Hospital, even standing behind reception desks, as photos that circulated online showed. Protesters gathered outside the hospital hosting rallies and press conferences.

They were all there because agents had previously brought in Milagro Solis-Portillo, an immigrant from El Salvador, for medical care following her detention. They spent 15 days in the hospital waiting for Solis-Portillo’s discharge before transferring her to another hospital and then taking her into custody, according to local news reports.

In a statement, officials from Dignity Memorial Hospital said they could not legally prohibit law enforcement from being in public areas.

That’s true, say legal experts: Waiting rooms and lobbies are considered public spaces in hospitals. But agents cannot move through hospitals without limits. Law enforcement officials are not allowed to search for people in exam rooms or other private spaces without a federal court warrant.

When agents bring in someone who is in their custody and needs medical care, the application of the law can be more murky.

According to Richardson at the hospital association, 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, she explained.

And if law enforcement officers do go inside exam rooms, they may hear medical information while on guard. But that isn’t necessarily a privacy violation, according to federal rules. The HIPPA Privacy Rule, the law that sets privacy standards for medical information, has a provision that allows for “incidental disclosures” of information as long as “reasonable safeguards” are applied.

“The hospital will, and the doctor will make reasonable attempts to protect the patient’s privacy.” “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,” Richardson said.

HIPAA protects the disclosure of medical records, which include names, addresses and social security numbers along with health conditions. State law also requires health facilities to protect this information. According to guidance from the attorney general’s office, health facilities should consider a patient’s immigration status confidential.

At the same time, some disclosures are required if law enforcement can prove lawful custody or show an appropriate warrant. A federal court warrant signed by a judge grants law enforcement immediate access to information or to search a particular area, while an ICE administrative warrant does not require immediate compliance.

Health Workers in ‘Precarious’ Situations 

Health facilities generally direct frontline workers not to engage with immigration agents, but rather to immediately contact security or management.

One particular incident at a Southern California surgery center stands out, in conversation with health workers.

On July 8, federal agents targeted three landscapers who had parked outside of the Ontario Advanced Surgical Center. They chased one of the men inside on foot, according to a felony criminal complaint filed against two health care workers in the U.S. District Court for the Central District of California.

In videos of the incident posted online, a masked agent wearing a vest labeled “POLICE ICE” on the back holds a weeping man by the shoulder inside the center while several workers in scrubs stand by. At multiple points in the video workers ask the officer for identification; one worker says, “this is a private business.”

Two workers, Danielle Davila and Jose Ortega, tell the officer to leave. Davila moves between the officer and the man, saying “Get your hands off of him. You don’t even have a warrant.”

Ortega puts an arm between Davila and the officer and says “You have no proper identification.”

The officer says to both workers “You touched a federal agent.” Then Davila responds, “I’m not touching you.”

Davila and Ortega were later charged with two felony counts of assaulting a federal officer and conspiring to prevent a federal officer from performing their duties.

Last week the felony charges were dismissed and both Davila and Ortega pleaded not guilty to a subsequent misdemeanor assault charge. A spokesperson for the U.S. attorney’s office declined to comment on the charges.

Davila’s defense attorney Oliver Cleary said his client believed she was doing the right thing by asking for credentials and a warrant.

“You can’t just come in where people are getting medical care and whisk them away,” Cleary said. “She didn’t know who these people were. They didn’t tell her who they were, and as far as she knew this was a patient of the clinic.”

Carlos Juárez, Ortega’s defense attorney, said arresting and charging health workers with crimes for asking to see a warrant and identification puts them in a “precarious” and “dangerous situation.”

“They did what they needed to do and what they had a right to do,” Juárez said. “What I hope is it doesn’t have a chilling effect on other health care workers.”

Workers Say Additional Training Can Help

Around the state, health workers say they’d like to see management provide additional guidance on how to respond to such scenarios if they were to play out in their workplace. Some workers are providing training themselves.

Adriana Rugeles-Ortiz, a licensed vocational nurse at Kaiser Permanente Modesto Medical Center, has been leading “Know Your Rights” sessions at her hospital and in her community as part of her union, SEIU-United Healthcare Workers West. She said some of her coworkers have expressed anxiety over some of the situations they’ve seen play out in other hospitals.

“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,” Rugeles-Ortiz said.

Dr. Douglas Yoshida, an emergency room physician at Stanford Health Tri-Valley in Alameda County, said additional guidance and training for workers at medical facilities could be of great value.

“I think as health care providers, we need to deliver good health care to these patients, just like any other patient, and we need to protect their rights,” Yoshida said. “I mean, personally, if someone comes in in ICE custody, within the limits of the law, I want to do everything I can to help [patients.]”

The hospital in Pleasanton that Yoshida works in is located near the county’s Santa Rita Jail; staff, he said, have been used to a law enforcement presence. But the recent incident at John Muir Medical Center, about 30 miles north, as well as the criminal charges filed against the southern California surgery center workers have set people on edge, Yoshida said.

“Normally, health care workers have no reason to fear law enforcement,” he added, “but we’re in uncharted territory.”

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

This article was originally published on CalMatters and was republished under the Creative Commons Attribution-NonCommercial-NoDerivatives license.