Caring for Patients in Immigration Custody: Clinical and Legal Considerations for Emergency Medicine Clinicians.

Abstract

Emergency departments (EDs) are increasingly sites of interaction between clinicians and federal immigration authorities. Recent shifts in federal enforcement policy have intensified these encounters. Patients now more frequently arrive in custody, accompanied by immigration enforcement officers who may assert control over communication, decision-making, or access to patients. These circumstances introduce challenges for maintaining standard clinical practice. Clinicians may encounter situations in which patient confidentiality, informed consent, and independent medical judgment are difficult to operationalize in the presence of immigration enforcement officers. In addition to impacts on patient care, these encounters may contribute to clinician moral injury and distress, particularly when emergency medicine (EM) clinicians feel pressured to compromise patient privacy, deviate from standard practices, or navigate conflicts between enforcement priorities and patient care priorities. Uncertainty regarding institutional policy and the appropriate limits of immigration enforcement authority may exacerbate tensions related to liability and compliance. For patients, disruptions in care and delays in treatment may increase the risk of adverse outcomes. In response to these urgent concerns, the National Immigration Law Center (NILC), a leading advocacy organization in U.S. immigration, has developed Advocating On Behalf of Patients in ICE Custody: A Resource for Health Care Providers and Medical Staff, a national resource guide outlining practical considerations for clinicians and healthcare institutions caring for patients in immigration custody. In this commentary, we build on this resource to provide practical, bedside-oriented guidance for EM clinicians when interacting with immigration enforcement officers or caring for patients in immigration custody. We examine the implications of immigration enforcement within healthcare settings while articulating a path forward that protects patient rights, clinical integrity, and the ethical foundations of medical practice. The following highlights clinical questions that EM clinicians may have when caring for patients in immigration custody or interacting with immigration enforcement officials in hospital settings.