Healthcare Professionals' Experience, Training, and Knowledge Regarding Immigration-Related Law Enforcement in Healthcare Facilities: An Online Survey

Examining the Presence of Border Patrol Agents in Hospitals in South Texas

U.S. policy dictates that immigration enforcement should not take place in or near "sensitive locations," such as healthcare facilities, but Border Patrol agents are often required to accompany detained border crossers to hospitals for medical care. There is little understanding of the presence of Border Patrol agents within healthcare facilities. This study is the first to examine the presence of Border Patrol agents in healthcare settings and its possible impact on the willingness of undocumented individuals to access healthcare. We conducted interviews with 57 emergency medical services (EMS) personnel working in one county in South Texas. Interviews were held between November 2023- January 2024. Interview transcripts were coded using NVivo 14 and thematic analysis was performed on the transcript data. There is a regular, highly visible Border Patrol presence in healthcare settings in the community of study. In many cases, participants stated that they saw Border Patrol agents every time they brought a patient to the hospital. Hospitals are listed as sensitive locations for immigration enforcement, but policies that require agents to accompany detained border crossers result in a near constant presence of Border Patrol agents in hospitals. The regular, visible presence of Border Patrol agents at hospitals in the study community may deter community residents without legal status from seeking healthcare.

Creating Barriers to Healthcare and Advance Care Planning by Requiring Hospitals to Ask Patients About Their Immigration Status

Florida is currently collecting data on the "costs of uncompensated care for aliens who are not lawfully present in the U.S." (Statutes of Florida, 2023). The Florida data collection law, enacted in 2023, is part of aggressive anti-immigrant legislation. Hospitals accepting Medicaid must inquire about patients' immigration status and submit de-identified reports. In August 2024, the Governor of Texas signed an Executive Order comparable to the Florida statute. Although presented as a data-collection measure, the legal requirements have far-reaching consequences. The potential adverse impacts on immigrants' health pose bioethical concerns. Immigration-related inquiries create barriers to healthcare access and advance care planning, exacerbating healthcare disparities and presenting ethical concerns. This article examines the effects on immigrants and the resulting ethical challenges, including respect for persons, beneficence, non-maleficence, and justice. The article proposes recommendations for mitigating these challenges, including community outreach, patient education, policy development, in-service education, and advocacy. While the legal requirements apply specifically to Florida and Texas, the ethical issues have nationwide relevance.

Unstable gynaecological patient with an ankle monitor: implications of US Immigration and Customs Enforcement's Alternatives to Detention programme in the healthcare setting

We review the case of an unstable gynaecological patient in the USA who presented with profuse vaginal bleeding after spontaneous miscarriage and was ultimately diagnosed with a uterine arteriovenous malformation managed with interventional radiology embolisation of her uterine artery. Her case was complicated by the presence of an ankle monitoring device which had been placed by US Immigration and Customs Enforcement as part of the Alternatives to Detention programme in which she was enrolled during her immigration proceedings. The device prompted important considerations regarding the potential use of cautery, MRI compatibility and device-related trauma, in addition to causing significant anxiety for the patient, who was concerned about how the team's actions could affect her immigration case. Discussion of her course and shared perspective highlights the unique clinical and medicolegal considerations presented by the expanded use of ankle monitoring devices for electronic surveillance (or 'e-carceration') of non-violent immigrants and others.

The Boston Medical Center Immigrant Task Force: An Alternative to Teaching Immigration Law to Health Care Providers

As healthcare providers engage in the politics of reforming and humanizing our immigration and asylum "system" it is critical that they are able to refer their patients whose health is directly impacted by our immigration laws and policies to experts who can help them navigate the system and obtain the healthcare they need.