Doctors, nurses speak out about immigration enforcement in hospitals

In the days since an ICU nurse in Minnesota was fatally shot by federal immigration officers, groups representing doctors and nurses have spoken out to denounce the tragedy.

Alex Pretti, a nurse who worked at the Minneapolis VA Medical Center, was shot and killed by Border Patrol agents Saturday. The incident has spurred more protests against U.S. Immigration Customs and Enforcement, and healthcare groups have called for a thorough and transparent investigation.

But in the past few days, medical groups have spoken out more broadly against ICE enforcement activities in hospitals.

The American Medical Association issued a statement Monday calling out ICE interactions in hospitals.

David H. Aizuss, MD, chair of the AMA’s Board of Trustees, “The American Medical Association is deeply concerned by reports of immigration enforcement activity in and around hospitals and emergency rooms—a tactic fueling fear among patients and hospital staff alike.”

Aizuss also pointed to the prospect that some people who need help may not be coming to the hospital for fear of encountering an ICE agent.“When people are afraid to seek medical attention for themselves or their families, it threatens their health, impedes the ability of physicians to render care, and ultimately undermines basic trust in our health care institutions,” Aizuss said. “To fulfill our oath and best serve our patients, physicians must be able to work in spaces that create a sense of safety for all, not fear for our most vulnerable.”

Keeping the ER safe

The American College of Emergency Physicians issued a statement Tuesday saying that emergency departments need to “remain places where all individuals can safely seek emergency medical care without fear.”

The group said it supports emergency departments, doctors and other providers in not asking about or disclosing immigration status.

“The focus of emergency medicine physicians and the care team is, and must remain, on the medical needs of the patients we treat and the communities we serve,” the group said. “We oppose any action, including immigration enforcement activity, that may discourage individuals from seeking and receiving necessary emergency medical treatment.”

A few days before Pretti’s death, the Minnesota Medical Association held a press conference last week outlining concerns from doctors about immigration enforcement interfering with patient care.

Dr. Lisa Mattson, president of the Minnesota Medical Association, said at the press conference, “I personally have been made aware of the presence of ICE agents in our hospitals.”

She said she’s been given reports of ICE agents that are “refusing to leave the room for private exams” of patients and staff experiencing “rude and harassing behavior from ICE agents.”

The American Nurses Association has called out for an independent investigation into Pretti’s killing.

On Monday, the group went a step further, calling for nurses to write to members of Congress and demand an “immediate end to federal immigration enforcement efforts that impede a safe workplace environment and/or breach of HIPAA requirements, and the ability to provide care in all healthcare settings.”

The American Nurses Association also said it wants Congress to block additional funding for immigration enforcement until there is more oversight of immigration officers “within our communities and care settings.”

“When policies threaten safety, access to care, and the public’s trust, nurses have an ethical duty to speak out and demand change,” the ANA letter to its members said.

Department of Homeland Security Assistant Secretary Tricia McLaughlin told Axios that ICE agents will accompany patients to hospitals for medical care if needed, but ICE does not conduct enforcement at hospitals.

Patients avoiding care

SEIU Healthcare Pennsylvania, the state’s largest healthcare union, issued a statement Tuesday denouncing the killing of Pretti and speaking out against more funding for ICE. The group also pointed to reports of patients avoiding treatment.

“We are hearing from patients who have tearfully told us they are terrified of leaving their homes to seek our care,” the union said. “Cancer patients who have missed chemo treatments, expecting mothers who skip essential prenatal care. We want to let them know that we are committed to ensuring our hospitals, clinics, nursing homes and home care programs continue to be protected places where everyone can safely receive care, and expect our employers to make the same commitment.”

The Oregon Nurses Association issued a statement over the weekend denouncing the killing of Prettti, but also pointed to nurses being disturbed by their encounters with ICE agents in Oregon.

“ONA members in Oregon are reporting growing fear and distress as they encounter federal agents in healthcare settings,” the group said.

“The killing of a nurse is intensifying these fears and could create unsafe conditions for patients, their families, and frontline caregivers alike,” the Oregon group said.

The need for training

Eric Yun and Shloka Joshi, attorneys at Archer & Greiner, stressed the importance of hospitals and health systems understanding protected spaces when it comes to law enforcement, including immigration enforcement.

Read more: Navigating ICE interactions in healthcare settings

Previously, the Department of Homeland Security recognized the need for restraint in enforcement activities in hospitals. Under the Biden Administration in 2021, the department issued a memorandum to expand the scope of protected areas to include healthcare facilities broadly, as well as areas near protected areas. President Trump rescinded that memo shortly after taking office last year.

ICE and other law enforcement have wide latitude in areas accessible to all visitors, such as waiting rooms and parking lots, the attorneys say. But in exam rooms and other areas where patients have a reasonable expectation of privacy, law enforcement officers usually need a warrant before conducting searches, they said.

Yun told Chief Healthcare Executive® in a December interview that healthcare staff need to know areas that remain protected.

“Staff should have a basic understanding of where it is that generally only patients and staff are allowed, versus anybody who can come in and walk on the street, and just wait there, like a waiting room, and public corridors versus everywhere else, essentially,” Yun said.

Joshi added that health systems should be giving clear guidance to doctors and nurses. Training should include those working nights and weekends when hospital leadership and the health systems’ counsel may not be immediately accessible.

“Staff really shouldn't be burdened with having to review a warrant and figure out if it's signed by an appropriate person,” Joshi says.

“What we want to make sure frontline staff and any staff are really able to do very quickly is know they need to ask for whatever that underlying document is,” she says. “They need to make it very clear to any law enforcement officials, ICE included, who are trying to enter premises, to be able to say with confidence: This is a private area.”

While Yun and Joshi acknowledged it’s not realistic to expect healthcare staff to be legal experts, health systems should provide enough guidance to know when they should reach out for assistance from managers or the hospital’s counsel if immigration agents are seeking access to protected areas.

“Have the frontline staff who are going to be dealing with these issues, at least be able to recognize where there's an issue and where they need to maybe stop and take a beat, and have the confidence to do that and say: I need to circle back with my supervisors,” Yun said.