Do No Harm
ICE Tactics Have Created a Public Health Emergency
Fifteen years ago, I stood in Madison Square Garden with my graduating medical school class and together we took an oath promising, “I will remember that I remain a member of society, with special obligations to all my fellow human beings.”
In a recent article in the New England Journal of Medicine, Drs. Alice T Chen and Vivek H. Murthy called on physicians to use their voices to advocate for the health of patients and communities during dangerous times.
The events playing out in Minneapolis and across our country have created a dangerous situation for our patients and our communities and we have an obligation to stop it.
Fear of U.S. Immigration and Customs Enforcement (ICE) operations are causing a significant increase in missed medical appointments among immigrant communities, with reports showing patients skipping or delaying doctor’s appointments, prenatal visits, and cancer treatments.
A recent survey conducted by The New York Times found that 50% of immigrant adults report skipping or postponing healthcare because of fear about their or a family member’s immigration status. Notably, this includes 14% of lawfully present immigrants and 8% of naturalized citizens.
That fear has very real consequences. When people delay care, treatable issues can progress into more severe conditions. In my own practice as an emergency physician, I have witnessed several instances of patients delaying their medical care and the consequences that follow.
I recently cared for an elderly hispanic man who presented to the emergency department with weakness and severe dehydration. He had a history of diabetes and when I checked his blood sugar it returned back more than five times the normal value.
The patient pulled out a pill bottle containing tiny broken bits of diabetes medication. He told me that he had cut his medication into pieces to ration it because he was scared to go to the pharmacy for his refill.
I treated a young man involved in a high-speed motor vehicle accident. He sustained life-threatening injuries and needed to be rushed to emergency surgery.
When I called his parents to make them aware, his mother dropped the phone and began crying. She was undocumented and afraid to come to the hospital and made me promise that I would call her as soon as he was out of surgery.
During that same shift, I cared for a young undocumented woman. She was six weeks pregnant and looked very pale. She told me that she had been having vaginal bleeding for three full days. She delayed seeking care because of her fear of reports of immigration officers being present outside of hospitals.
For decades, ICE had not been allowed to engage in enforcement actions at sensitive locations like schools, churches, and hospitals. However, last year, the Trump administration amended that policy thereby allowing ICE to enter and detain individuals in any location.
Since that policy change, health care providers in cities targeted by ICE have reported children presenting at emergency rooms unaccompanied, delayed diagnoses of life-threatening illnesses, and children as young as six years old presenting with anxiety due to fears of family separation.
It bears noting that I come into contact with law enforcement officers regularly in my emergency department and in my fifteen years of practice, I have never once observed a patient’s medical rights violated or had medical care impeded by a state or local law enforcement officer.
That’s what makes the federal immigration response so frightening. ICE tactics and deportation fears have created a public health emergency and we as physicians have an obligation to protect our patients and our communities.
I take that obligation very seriously and I’m proud to say that my governing board, the American College of Emergency Physicians (ACEP), does as well. Going forward, there are several measures we can take to ensure the safety and well being of patients and those who care for them.
Uninterrupted Access to Care
All patients - regardless of their background or immigration status - must be able to access medical care without fear or delay. Hospitals and medical centers must create policies and protocols that limit federal immigration agents from entering patient care areas, including areas of the hospital that include hallway beds and lobby spaces that are regularly used for patient care.
Patient Privacy
Every effort should be made to protect patients’ right to privacy while they receive healthcare. Hospitals and clinics should provide clear, visible signage and resources that explain patients’ legal rights and relevant policies and protocols. This should include guidance on what to expect and how to respond when interacting with federal agents or law enforcement officers.
Protection of Medical Personnel
Physicians, nurses, and support staff must be able to perform their duties without interference or obstruction as timely care should never be hindered. Making sure medical personnel can quickly reach and care for critically injured patients is a basic and vital part of life-saving care.
It’s been reported that Renee Good was found to have a pulse eight minutes after she was shot, and yet when a physician asked to be allowed to evaluate her he was told by a masked federal agent “I don’t care”.
The problem is that a great many of us do care.
We care, not just because we have taken an oath but because beyond our scrubs and white coats, we are human beings who believe that all individuals regardless of their race, sex, or immigration status deserve to be treated with compassion and dignity.
In a sense, we all have a duty to raise awareness when we see the rights of others being infringed upon. Failing to act can itself be a form of injustice.
As members of a society, each of us share a special obligation to our fellow human beings. You don’t need an oath for that. You just have to care.
David Zodda, MD
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