The man lay on the sidewalk in New York City where he was wounded by a gun, clutching his side.
Emily Bolgaard, a social worker who distributes supplies to the homeless through her nonprofit, found him and got the phone ready to dial 911. However, the man asked her not to call.
“No, no, no,” he said.
Bolgaard tried to explain that federal law required hospitals to treat him regardless of his immigration status, but he was terrified.
“He said, 'If I went to the emergency department, it would put me on their radar,'” she recalled in an interview that spoke of the incident.
Nationwide, doctors, nurses and social workers are increasingly concerned that people with serious medical conditions, such as injuries, chronic illnesses and high-risk pregnancy, are providing medical care for fear of being arrested by immigrant staff. Doctors said they saw a sharp rise in patient anxiety and no-show rates in appointments as the Trump administration unveiled plans for a massive deportation and rescinded Biden-era policies to protect spaces such as hospitals, clinics and churches from immigration enforcement.
Healthcare officials say if the trend continues, the list of results can be lengthy. Infectious diseases are circulating unnecessarily. worsening healthcare costs due to untreated chronic diseases. And especially dangerous birth complications for women who spend too long to seek help.
According to a survey conducted by KFF, a health policy research institute, 31% of immigrants The immigrant status (either or their family members said they were worried about it having a negative impact on their health. Approximately 20% of all migrants surveyed said they were struggling with their diet and sleep. 31% reported worsening stress and anxiety.
A White House spokesman did not respond to a message seeking comment. When the administration announced on January 21 that it had ended protections at hospitals, a statement from the Department of Homeland Security said the new policy was “intended to enforce immigration laws and catch criminal foreigners.”
Research shows that immigration crackdowns lead to fewer access to birth outcomes and reduced mental health, expiration of care, and types of public programs that reduce disease and poverty overall.
“We are not only creating very serious health risks, but also economic risks in our country in the long term,” said Julie Linton, a pediatrician and member of the American Academy of Pediatrics' Federal Committee Committee. “These policies create very realistic fear and uncertainty for people, and have a major impact on their ability to function on a daily level.”
Chronic condition
Many immigrant communities suffer from a high proportion of chronic diseases such as hypertension and diabetes. This can lead to heart attacks, strokes and other serious complications if left untreated.
So doctors worry about patients like Maria, a 47-year-old pre-diabetic woman who has been to the same primary care clinic since she arrived in the United States from El Salvador 20 years ago. Even during the first Trump administration's crackdown on immigrants, she continued to seek medical care. However, when protections around hospitals and clinics were revoked earlier this year, Maria cancelled her appointment to check her blood sugar levels.
“We're in the clinic and are very scared of ice coming while we waited for them to be called,” she said in Spanish.
When Maria asked not to disclose her last name, she said she was in a state of “continuous anguish.” She said she was working on a plan to take care of her child, an American citizen, in case she and her husband are deported.
One of her 15-year-old daughters is being treated for fatty liver disease, while another 11 need treatment for their developmental status. Their eldest daughter has an appointment with another doctor in June. Maria and her husband don't want to interrupt her care, but they are worried about taking her by themselves. “It's very complicated,” Maria said. “I can put myself at risk for my child. But if it's for my own health, I prefer to let it go.”
However, the consequences of abandoning regular medical care can quickly become serious. Jim Manzia, president of St. John's Community Health Network in Los Angeles, described one of the diabetic patients who stopped competing in the diabetes education class every week. When clinic staff were called women, they discovered she was even afraid to go to the grocery store, and they had given tortillas and coffee for days, he said.
“We're grateful that we got to her and that she came in,” Manzia said. Its network serves an estimated 25,000 undocumented patients in more than 20 locations. Examinations at the clinic showed her blood sugar level was dangerously high.
“That's what we're trying to see more and more,” Manzia said. “I'll break my heart to talk about it.”
Acute care
For doctors working in emergency care settings, discontinuation of immigration has been revealed through several unusual indicators. For example, Dr. Amy Zidan, a physician in the Atlanta emergency room, said requests for interpretation of Spanish in the emergency department at her hospital fell by more than 60% between January and February.
Theresa Cheng, an emergency room doctor at the Zuckerberg San Francisco General Hospital and Trauma Center, said one of her residents saw an immigrant patient who suffered multiple facial fractures from the assault but had not sought care for them for more than two weeks. “There's an incredible fear,” Dr. Chen said.
In late January, Dr. Chen said she saw a patient who had arrived with severely untreated diabetes. The patient, an undocumented woman, said she was scared and was waiting for help. She passed away that day.
Dr. Carolina Miranda, a family doctor in the Bronx, spoke about a patient who was granted exile but feared ice, but failed to show up due to the appointment of a doctor about a possible brain tumor.
Similar delays or cancellations occur between pregnant women and new mothers, according to obstetric gynecologists across the country. Dr. Caitlyn Bernard, an obstetrician in Indiana, said the patient skipped the postnatal visit and explained that she would no longer leave the house. On the obstetrics floor at a San Diego hospital, multiple staff members said they saw an overnight decline after the inauguration of the number of immigrant women suffering from acute problems during their pregnancy.
“Obviously those women still exist,” said one doctor who asked her not to be identified as her employer had barred her from speaking publicly about the issue. “I'm worried that over time it will increase the mortality rate for mothers.”
Children's health
Many of the children of immigrant parents who skipped their appointments or left unfilled medication are American citizens. However, in mixed-status families, parents at risk of deportation are often reluctant to risk going to a clinic or pharmacy.
Pediatricians at health centers who care about underserved populations in the California Central Coast reported a 30% increase in no-shows in child appointments. Many of the people who brought their children and were featured elsewhere for professional care, such as speech therapy and autism assessment, said they were too scared, and asked him to be identified precisely because he was not allowed to speak publicly.
Dr. Tania Caballero, a pediatrician at Johns Hopkins, has seen patients at health centers for an unserved group called the Baltimore Health System, but she said she has encountered parents who don't want to go to a fearless emergency room, parents of children with chronic conditions like cerebral palsy and asthma, and parents of children with chronic conditions like diabetes.
“I tell the patient, “I can't control what happens outside of my space. I can't control whether someone comes into my space or not, but you know me. I have the tools and I want to help you navigate this journey and do it together,” she said.
Some parents of other disastrous children, such as those undergoing cancer treatment, want their child's condition to actually protect them. Some asked pediatricians a letter describing their child's medical requirements, hoping that immigration officials detaining them might be convinced to be sure their child needs to stay in the United States to survive.
Dr. Lisa Gwyn, a pediatrician in South Florida, He said patients' attendance rates are plummeting as patients across the Caribbean and South America are missing out on pediatric vaccines needed to prevent diseases like measles, pneumonia and pertussis.
Dr. Gwyn also worries that children who had experienced serious trauma before coming to the US without seeing her are not connected to social workers and psychologists who can help.
“Imagine a child living in a house where everyone is scared. They came to this country feeling that they are no longer scared,” she said. “We know that stress doesn't help health. Duration. Children don't perform much in school, they have mental health issues, depression, and anxiety.”
Hospital dilemma
Some health facilities say they comply with immigration staff. Nyu Langone of New York City sent a note to an employee warning him not to try to protect illegal immigrants. However, many other health centers and organizations have found ways to take a stand, displaying information on the wall “know your rights” and telling staff not to record immigration status in their patients' medical records. ”
Last week, the New England Journal of Medicine published an article by two doctors and lawyers detailing how doctors continue to provide health care and legally push back in the face of several ICE requests.
The St. John's Clinic Network in Los Angeles recently launched an ambitious home visit program in which doctors, nurses and medical assistants conduct exams and visit patients who live in order to deliver medication. They aim to inform all undocumented patients of this option.
In the New York area, the Hospital Association suggested specifying a “hospital contact” that could be paged to quickly direct agents to private offices and asking them to view the signed warrant.
In the emergency room at University Hospital, a Newark safety net facility, staff will hand out cards in Spanish and other languages to remind patients of their rights. “You have the right to refuse consent for immigrants and police to search themselves, your car, or your home,” Card said.
But there, the fear is obvious. Annaly M. Baker, an emergency doctor, said she saw a young woman who said her partner beat her until she was unconscious. Covered with welt and bruises, she waited for hours to enter.
Dr. Baker also dealt with the stabbed minors. She needed the consent of his parents to treat him, but the boy was keen about providing details about them, fearing that they might get caught up in the migrant dragnet.
Still, what bothers Dr. Baker the most is the people who don't come in at all.
“The tragic messages to these people will be in the shadows and I hope you don't die.”
Sarah CliffReports of contributions.
