Within hours after taking office on Jan. 20, 2025, President Donald Trump revoked a policy that protected designated areas such as schools, places of worship, hospitals, health clinics and doctors’ offices from immigration enforcement activities like arrests, searches, surveillance and questioning of people.
The “sensitive locations” or “protected areas” policy took effect in October 2011 during the Obama administration. The goal was to give people access to essential services without fear of enforcement activities by Immigration and Customs Enforcement or Customs and Border Protection agents.
President Trump had kept the policy in place during his first term, although he revoked a similar guidance around courthouses.
In October 2021, the Biden administration expanded the policy, broadening the definition of protected areas to include social service organizations, emergency response sites and places where children gather. It also reinstated protection around courthouses.
Following the removal of the policy in January, a Department of Homeland Security spokesperson said in a statement, “Criminals will no longer be able to hide in America’s schools and churches to avoid arrest. The Trump Administration will not tie the hands of our brave law enforcement, and instead trusts them to use common sense.”
Although hospitals and health clinics have not been at the forefront of conversations after the policy removal, and there have been no confirmed reports of immigration arrests in hospitals at the time of the publication of this article, the change does affect them. The policy removal has put many health providers and immigration lawyers in uncharted territory, raising legal questions and medical concerns about patient care.
“You can’t just look back and be like, ‘What did we do before when this happened a lot,’ because it hasn’t,” says J. Anna Cabot, director of the Immigration Clinic and assistant dean of clinical programs at the University of Houston Law Center.
Dr. Holland Kaplan, an assistant professor at Baylor College of Medicine and an internal medicine physician at a large safety-net hospital in Texas, worries that patients would delay seeking care out of fear of immigration officials. Research shows that immigrants who delay care out of fear could face worsening health conditions and higher rates of hospitalization, and recent news reports have documented the impact. Fear of detention and deportation can also take a mental toll on immigrant families.
Anecdotally, Kaplan and her colleagues in Texas have already seen a drop in the number of patients who are immigrants without legal documentation.
“I’ve heard from many patients who have presented to the hospital later than they would have otherwise and they explicitly told me it’s because they were afraid that either they would be deported or that their family, who may be visiting them, would be deported,” Kaplan says. Kaplan says her views in the interview with The Journalist’s Resource are her own and don’t represent those of the institutions she works for.
The legal complexities of the removal of the sensitive location policy at hospitals and health clinics also raised many questions for Kaplan.
“I’m a mere physician,” Kaplan says. “I don’t know the legal aspects of any of this. I don’t know what to do if ICE agents are trying to apprehend my patients. How I, as a physician, can continue to advocate for my patients while adhering to the law?”
To address the questions and provide guidance for hospitals and their staff, Kaplan teamed up with Cabot and Dr. Peter Ubel, a physician and behavioral scientist at Duke University, and published a perspective article in the New England Journal of Medicine on April 30.
Guidance for hospitals
For health care settings, the removal of the policy means that immigration officials and law enforcement agencies acting on their behalf, “are no longer guided to avoid conducting enforcement actions — including arrests, detentions, and interrogations — in or near spaces where people seek medical care,” according to a guide by Physicians for Human Rights published in March.
However, the change does not grant immigration officials unrestricted access to all areas of health care facilities or to patient information, write Kaplan and her co-authors in NEJM. The Fourth Amendment of The Constitution, which protects people from unreasonable search and seizure by the government, remains in effect, as does the Health Insurance Portability and Accountability Act, or the HIPAA Privacy Rule, a U.S. law that protects patients’ private health information and sets rules for how that information can be shared.
Following the removal of the protected areas policy, Caleb Vitello, the ICE acting director, issued a memo expressing “great faith in the judgment of our law enforcement personnel,” and directing ICE officials in charge to make case-by-case decisions on whether, where and when to conduct enforcement actions in or near previously protected areas.
To prepare, medical and legal experts have issued detailed guidelines for hospitals and health care workers. Two of the guides that we have selected to summarize below include the NEJM perspective article by Kaplan and her co-authors and the Physicians for Human Rights’ guide.
Although geared toward health providers, the guidelines and recommendations can help journalists prepare when reporting on their local hospitals and share information that helps patients learn what their rights are.
Individual rights
- All patients in the U.S. have legal rights to emergency care, privacy and equal protection, regardless of immigration status. In addition, all individuals, including staff and patients, have the right to remain silent when questioned by law enforcement.
Legal considerations
- Immigration officials may enter public spaces, such as lobbies, parking lots and sidewalks, without consent. But in order to enter private spaces, such as exam rooms, immigration officials need a valid warrant. They can enter these areas under special circumstances, such as threats to public safety.
- Immigration agents may look at anything in “plain view” in a public area, meaning they may visually inspect anything — including papers and files — that is clearly visible from the visitors’ side of the reception desk. But they may not move an object in plain view to expose other portions of it or what is under it.
- Under HIPAA, health care providers are not obligated to provide patients’ protected health information to anyone without a judicial warrant or subpoena. A judicial warrant must be signed by a judge and list a state court or U.S. district court. (Protected health information, or PHI, includes information such as a patient’s name, demographic information, images, immigration status and hospital discharge date.)
- Administrative warrants from the Department of Homeland Security, such as Form I-200 or I-205, are not sufficient to compel health professionals to release patients’ protected health information.
Recommended hospital policies and preparation
- Hospitals are advised clearly distinguish public and private areas within the facility. They can use signage, closed or locked doors, and access restrictions to mark private areas, such as clinical workspaces and waiting rooms, according to the NEJM perspective article.
- They should establish internal protocols for responding to ICE’s presence or requests.
- They should have a designated institutional response team to handle interactions with immigration officials and ensure access to legal counsel during enforcement encounters.
Recommended conduct for staff and clinicians
- Staff are advised against physical confrontation with immigration officials. Instead, they should report unauthorized access to leadership and legal teams.
- Staff are advised to avoid documenting immigration status in medical records when possible. There are exceptions: At least two states, Texas and Florida, require hospitals to ask patients about their immigration status, although patients are not required to answer the question. Those two states are required to provide regular reports to the state health agencies. Florida has a dashboard for hospital visits by immigrants without legal documentation. Experts have called the Florida dashboard misleading. They have also cast doubt on Texas’ report on the cost of care of migrants. An August 2024 brief by the health policy nonprofit KFF explains the potential impacts of such requirements by hospitals.
Clinical ethics
- Health providers are advised to decline to perform procedures requested by ICE that are not clinically needed, such as dental X-rays to determine age, or force-feeding detainees on a hunger strike. Without a court order, clinicians are not obligated to perform medical interventions that are not clinically needed.
Communication and surrogacy
- Health providers are advised to encourage all patients to complete legal forms naming surrogate decision-makers, such as family, friends or a clergy member, and preferably more than one.
You can also read “Police in the Emergency Department,” a toolkit for providers issued by the Working Group on Policing and Patient Rights in 2021.
It’s important to note that while some hospitals have started issuing guidance for their staff, some, including NYU Langone Health, have warned their employees against protecting patients who are immigrants without legal documentation and have said that they will comply with immigration officials, reported The New York Times.
Meanwhile, there have been efforts to restore the policy, including several lawsuits. Some states and local governments have also been providing guidance for residents, according to an April 11 article in Immigration Impact. On Feb. 6, Democratic Sen. Richard Blumenthal of Connecticut and Democratic Rep. Adriano Espaillat of New York reintroduced the “Protective Sensitive Locations Act” to limit immigration enforcement actions at sensitive locations.
Advice for journalists
- Profile patients who have been afraid to seek healthcare and how it has impacted them. “Have their conditions worsened? Have their children’s chronic medical conditions worsened?” Kaplan asks.
- Highlight that immigrants have often fled unsafe areas to find a safe place to live.
- Talk to immigration lawyers. And talk to health care providers.
- Be mindful of the terminology you use. The AP Stylebook advises against using the terms “alien, unauthorized immigrant, irregular migrant, an illegal, illegals or undocumented (except when quoting people or government documents that use these terms). Many immigrants have some sort of documents, but not the necessary ones.”
- Read our 2024 piece about health care for immigrants.
- Create a community guide. The page “Can Doctors Share My Personal Information with ICE?” created by the New York City-based nonprofit newsroom Documented is a good example.
Additional resources
- Immigration and Customs Enforcement information on enforcement actions near protected areas.
- The National Immigration Law Center’s fact sheet on the removal of the protected areas policy.
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