Authors:
Sanemba Fanny MD, Lauren Krenek MD, and Judy Levison MD
The past year was marked by reports of ICE apprehending undocumented immigrants while seeking medical care. Sara Beltran-Hernandez, a 26-year-old woman, was transferred to a detention center while awaiting brain surgery (1). Rosa Maria, a 10-year-old with cerebral palsy, was taken into custody after border patrol agents stopped her ambulance en route to the hospital then waited outside her hospital room until she was stable for transfer to a detention center (2,3). The Department of Homeland Security has a policy to avoid arrests at “sensitive locations,” including schools, health care facilities, and places of worship, unless prior approval is obtained or “exigent circumstances necessitating immediate action (4)” exist. Despite this policy, immigration law confrontations, even for non-emergent cases, are increasingly visible in the medical system as evidenced by these arrests. As physicians who care for immigrants from diverse backgrounds, these acts are unconscionable and undermine our efforts to provide compassionate care to all patients.
Hospitals and other health care facilities were not arbitrarily designated “sensitive locations.” Historically, hospitals were secular institutions with a moral obligation to treat those suffering from illness regardless of wealth, religion, or citizenship (5). In medieval Europe, hospitals served many roles: besides medical care, they provided shelter and food for vulnerable members of society (6). After centuries of scientific and societal advances, our modern hospitals uphold this moral obligation to provide medical care without discrimination. Now, when some of our community members are subject to immigration policies and actions that threaten their health and their lives, hospitals, health care facilities, and medical professionals need to reaffirm their mission to provide healing and protection for all.
Physicians and medical staff at a local Houston hospital recently encountered Raoul (name changed), a 20 year resident of the United States, who was arrested after a non-violent misdemeanor and placed in a detention center without necessary life-saving medications. After two months in detention, he was brought to the hospital for worsening illness and was diagnosed with cancer. Once hospitalized, 2 guards constantly remained in his room, even while physicians obtained a medical history and performed a physical exam, acts which are usually considered protected and confidential. The guards took names of all medical staff entering the room, successfully intimidating even the physicians; kept him in shackles that began to break down his skin; and denied his attorney access to him. The physicians, seeking to “do no harm” as they had promised to do on entering a career in medicine, realized they were unfamiliar their rights and that hospital policies did not delineate how to confront this situation. There will be more patients with similar stories ahead, and we need education about patient and clinician rights.
While there are mechanisms that restrict unauthorized disclosure of and access to medical and other sensitive information, such as the Health Insurance Portability and Accountability Act (HIPAA), recent events have revealed the lack of healthcare facility policies specifically aimed at protecting immigrant rights. It is imperative that hospital and other healthcare facility administrations establish clear policies to protect undocumented patients from unwarranted interactions with immigration law enforcement while seeking medical care. In addition, healthcare facility staff should receive education about immigrant rights and how to respond appropriately during encounters with officers attempting to take patients into custody. Such responses include identifying agents and asking for proper documents (7).
As individual physicians, we have a moral obligation to denounce injustice, speak against policies detrimental to our patients’ health, and protect our patients’ dignity and privacy. Upon entering this profession, we took an oath with some iteration of the following words: “in whatsoever house I enter, I will enter to help the sick, and I will abstain from all intentional wrong doing and harm […]. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets” (8). Healthcare providers owe it to our undocumented patients, many of whom may be afraid to seek medical attention due to fear of legal repercussions, to uphold our oath to ensure their privacy and safety.
References
- http://www.latimes.com/nation/la-na-hospital-seizure-20170223-story.html
- http://www.bbc.com/news/world-us-canada-41866595
- https://www.aclu.org/news/government-releases-10-year-old-rosa-maria-hernandez-after-aclu-files-lawsuit
- https://www.cbp.gov/border-security/sensitive-locations-faqs
- https://www.nlm.nih.gov/exhibition/islamic_medical/islamic_12.html
- http://broughttolife.sciencemuseum.org.uk/broughttolife/people/hoteldieu
- Saadi A, Ahmed S, Katz MH. Making a Case for Sanctuary Hospitals. JAMA. 2017;318(21):2079–2080. doi:10.1001/jama.2017.15714
- https://www.loebclassics.com/view/hippocrates_cos-oath/1923/pb_LCL147.299.xml;jsessionid=B413028729A2273C12A5A66CFF688926