H Kaplan et al. NEJM 2025; 392: 21: 2084-2086. Health Care in an Evolving Immigration Landscape — Providing Care while Upholding the Law
An excerpt:
In January 2025, the “sensitive locations policy,” which protected health care facilities and other designated areas from immigration enforcement activities, was rescinded. This change does not grant the officials unrestricted access to all areas of health care facilities or to patient information — the Fourth Amendment and the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule remain in place. Immigration officials may enter public spaces (e.g., lobbies) without consent, but they can access private spaces (e.g., exam rooms) only with a valid warrant or in exigent circumstances, such as threats to public safety…
Under the HIPAA Privacy Rule, health care professionals are not obligated to provide protected health information (PHI) to anyone without a judicial warrant or subpoena. The definition of PHI is expansive and includes a patient’s name, immigration status, and hospital discharge date. Administrative warrants from the Department of Homeland Security (such as Form I-200 or I-205) are not judicial warrants and do not compel health care professionals to disclose PHI. A judicial warrant must be signed by a judge and list a state court or U.S. district court on the document.
If an immigration official presents a judicial warrant or subpoena, health care professionals should verify its validity with their institution’s legal counsel before complying with it. They should escort the official away from private areas and document the official’s name and identification number, the nature of the request, and any actions taken, and obtain a copy of any documentation the official provides. They should not provide immigration officials with information beyond the scope of the warrant. When possible, they should avoid documenting a patient’s immigration status in the medical record, since that information could be used against the patient in legal proceedings….
If an official attempts to gain access to a private area by claiming there are exigent circumstances, legal counsel should be contacted. If an official forcibly enters a private area without legal authorization, staff should avoid physical confrontation, document the incident in detail (including names, badge numbers, and any statements made), and notify institutional leadership, their security team, and legal counsel as soon as possible…
In the past, immigration officials have pressured clinicians to transgress their clinical duties or to conduct evaluations or interventions that are not clinically indicated, such as certifying detainees’ fitness to travel for deportation…Without a court order, clinicians are not obligated to perform interventions that are not clinically indicated.
My take (borrowed in part from authors): “Health care professionals may face legal and ethical challenges as immigration policies evolve. By understanding their own legal rights and those of their patients, they can continue caring for patients while advocating for them and adhering to the law.”
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