As Trump’s immigration crackdown continues, hospitals have become a battleground |
There is a growing presence of immigration officials inside health care spaces. San Francisco General, pictured in 2022, and other California hospitals aren’t immune.
Over the past year, the Trump administration’s immigration crackdown has spilled into emergency departments and hospitals across the country. And with the federal government’s 2025 decision to allow immigration agents into sensitive locations like medical facilities and schools, hospitals have become frontlines of heated battles.
Thirty-two people died in Immigration and Customs Enforcement custody in 2025, the highest recorded number of deaths in more than two decades — and most died in hospitals near detention centers. The death toll in 2026 already outpaces last year’s. Detainees are often held in overcrowded conditions, with inadequate food, little to no health services and without their necessary medications.
In October, ICE stopped paying some of its onsite medical providers for detainee care, and a growing number of ICE medical providers have quit due to what they have described as “inhumane conditions” in detention facilities. In a country where an estimated 290,000 people have been detained in a single year, all of this adds up to more detained sick people flooding hospitals and emergency departments like the one I work at in San Francisco.
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Unlike doctors in private or even public clinics, who may turn patients away due to insurance status, emergency department physicians are required by federal law to treat or stabilize anyone with an emergency medical condition. The Emergency Medical Treatment and Labor Act ensures that people experiencing medical emergencies can count on emergency care regardless of who they are or how much money they have.
But even beyond the law, many doctors like me choose to work in the medical safety nets of our country, despite mounting pressures: worsening hospital overcrowding, a disastrous federal budget and Affordable Care Act tax credit expirations that will inevitably bring even more patients to our doors.
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What we could not have predicted was an immigration crackdown that would make the situation much worse.
Immigration officials are detaining people on hospital grounds. Some patients in immigration custody are brought for treatment after being injured while detained. Many more arrive because they developed serious medical conditions in detention or their chronic medical conditions spiraled out of control in the absence of medication or care.
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The result is the same: a growing presence of immigration officials inside health care spaces and increasingly frequent standoffs between those officials and the medical teams responsible for patient care.
Earlier this month, Minnesota physicians held a news conference describing the daily fear and anger caused by immigration officers obstructing patient access and interfering with doctors’ ability to provide care. In Portland, Ore., last month, ICE agents stopped and detained a family, including a 7-year-old girl experiencing a medical emergency, in the parking lot of an emergency department. Ohio lawmakers are considering House Bill 281, which would require hospitals in the state to permit immigration agents to operate inside medical facilities, thus laying the precedent for other states to follow.
Providers nationwide are being intimidated and directed to violate the Hippocratic Oath, sometimes by their own hospital administrators. They are pressured to share private, confidential patient information without consent. They are compelled to accept immigration officials as bedside decision-makers in medical situations that should be governed solely by evidence-based medicine and the patients themselves.
California has not been immune. Providers in Los Angeles cannot escape the new pervasive presence of masked, armed immigration officers inside hospitals. Two surgery center workers in Ontario (San Bernardino County) are facing federal charges after a confrontation with ICE officers. A new detention facility opened in California City (Kern County) in August, increasing ICE’s detention capacity in the state by over a third, and it has already been the target of multiple lawsuits and reports of medical negligence. At least seven new ICE offices and expansions in California have been leased, as of January, with the promise of an incoming ICE militarization surge similar to what is happening in Minnesota.
Responding to these dangerous trends, California recently passed Senate Bill 81, requiring health care entities to establish strict protocols that govern immigration enforcement in private patient care spaces, notify management of immigration enforcement requests and protect patient privacy related to immigration status. But this is not enough.
The moral injury inflicted on clinicians to abandon their oath and ethical duty to patients is immense. Absent clear institutional safeguards, clinicians are left to navigate this ethical minefield alone, with patients bearing the consequences. And when hospitals allow immigration enforcement to override medical judgment and patient privacy, they transform spaces of care into instruments of state violence, harming patients and providers alike.
Guest opinions in Open Forum and Insight are produced by writers with expertise, personal experience or original insights on a subject of interest to our readers. Their views do not necessarily reflect the opinion of The Chronicle editorial board, which is committed to providing a diversity of ideas to our readership.
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Organizations like the National Immigration Law Center have released guidelines and model policies on the care of patients in immigration custody. Meanwhile, the Service Employees International Union has issued tools and guidance to help health care spaces remain safe for all.
Hospitals and health care institutions must do more to protect all of our patients and the providers who take care of them. The integrity of our emergency departments — and the entire medical safety net — is at stake.
Dr. Theresa Cheng is an assistant clinical professor in the Department of Emergency Medicine at UCSF-Zuckerberg San Francisco General Hospital and a civil rights attorney.