In the course of a hectic day with a huge patient load, the last thing a hospitalist might expect to handle is a visit from immigration officials demanding access to a patient the federal government says is in the country illegally.
But that possibility, legal experts say, has risen considerably in the second Trump administration, and hospitalists and other hospital staff should have a plan in place and be prepared to put it into action if officials from Immigration and Customs Enforcement (ICE) show up at a hospital wanting access to protected areas.
President Trump has promised to oversee the “largest deportation operation in American history.” On the first day of his new term, he rescinded a Biden administration policy that protected certain areas—called “sensitive locations”—from immigration enforcement. These areas include hospitals, churches, and schools.
These policy shifts present challenges for hospitalists, who must balance patient care, legal compliance, and ethical considerations. Given their frontline role in inpatient care, hospitalists are often the first to encounter patients affected by ICE enforcement activities. Understanding how to respond in such situations is critical to preserving patient trust, maintaining hospital operations, and ensuring adherence to healthcare laws.
Tiffany Baldwin, senior counsel at the St. Louis-based Husch Blackwell law firm, where she specializes in immigration law, said physicians need to know what to do before seeing ICE walk through the door.
“When it happens, it’s scary, but if you know what to do, then it is much less scary and much less anxiety-producing,” she said.
In Texas recently, ICE agents arrived requesting access to a patient who was recovering from surgery. The hospital’s established protocol required ICE agents to present a judicial warrant before entering patient areas. Hospital leadership intervened, ensuring that the patient’s medical needs were addressed before any law enforcement action occurred, highlighting the importance of preparedness and adherence to hospital policies in managing ICE interactions effectively.
In a recently published overview on how hospitals and hospitalists should prepare, Ms. Baldwin and law firm partner Kelli Meilink said most hospitals should already have a policy on handling law enforcement visits, including those from ICE, and it’s largely a matter of re-familiarizing the staff with that policy and practicing putting it to use.1
A key aspect is an “internal communication plan to control the flow of information and lessen any disruption to patient care in these situations,” she said. This includes, ideally, a designated liaison knowledgeable about the rights and responsibilities who can be the point of contact with ICE until legal counsel can be reached. During off hours or overnight hours, a kind of “backup” liaison should be designated as the point of contact—and that person will reach the primary liaison should they not be on site at the time, Ms. Baldwin said.
“Staff should say that they do not have the authority to answer any of the agent’s questions and refer them to the authorized representative,” Ms. Baldwin wrote in the overview. “This will avoid any action on the part of your employees that could be interpreted as consent.”
A top concern is that a center, if caught off guard, might over-comply with ICE demands, which could have profound implications for patients at the hospital. Ms. Baldwin said that hospitals have not yet seen an increase in visits from ICE, although the lifting of the “sensitive locations” limitation is a sign that an increase is likely. But in other locations, when ICE has arrived, it has been with an expectation of deference.
They are “seeing, in some areas, where they come in without any warrant and expect to have the door opened and have the red carpet rolled out for them because they are ICE,” she said. They might be in plain clothes and gain access to a sensitive area when an unsuspecting staff member allows them in, or they might deliberately arrive at a late or overnight hour when there are likely to be fewer administrators to ensure the law is followed.
Another important point is to require a judicial warrant—one signed by a judge or magistrate—before allowing access to a patient. An administrative warrant—signed only by someone within the agency itself—is not sufficient. Ms. Baldwin said that some law firms advise simply complying if there is any type of warrant, so that a hospital is not seen as confrontational or obstructing justice. She said that is not the advice she gives because a judicial warrant demonstrates that there is a legal basis for detaining a patient.
“They should be able to get a judicial warrant if there’s probable cause,” Ms. Baldwin said.
If an administrative warrant is presented, the hospital doesn’t have to say whether a patient is at the hospital or not, and doesn’t have to direct ICE to a room. ICE officials might say they need access to a patient to prevent imminent harm or risk, and the hospital needs to evaluate all factors.
Ms. Baldwin emphasizes how important it is to deny entry if the proper documentation isn’t presented because it then becomes much easier for immigration officials to move about freely.
“Even if they had a judicial warrant and they had the ability to come in, there’s a scope: It limits the area, it limits the target,” she said. But, she added, “once they’re in, they really can go beyond that scope, and the hospital staff wouldn’t be able to stop them. They could say, ‘It looks like you’re going beyond the scope of this warrant,’ but they can’t physically stop them…. They have a lot of leeway once they are within a facility, once there’s that consent.”
Patient privacy is protected under the Health Insurance Portability and Accountability Act (HIPAA), and unfettered access to private areas could compromise that, Ms. Baldwin said. She says that immigration status should never be made a part of a patient’s electronic medical record, and typically, there is little need for hospitals to collect it at all—although there are certain health assistance programs for which it might be needed.
She also cautioned that anything ICE officials might hear—without so-called “unassisted ears”—can be actionable information. Information on any document left in view can also be used, she said.
Waiting rooms, cafeterias, and parking lots are not private areas, and ICE officials are free to question people there. To maintain privacy and to minimize disruption, private areas should be designated for patients receiving care and their loved ones.
“A staff member can simply say, ‘I can’t give you permission to enter. You must speak with our designated representative,’” Ms. Baldwin wrote in her review.
She also advises clients to “document everything”—from getting the agents’ names, badge numbers, business cards, and contact information, to seeing whether they comply with the terms of the warrant. She recommends recording all interactions.
If a patient is detained, find out where they’re being taken, she said. A hospitalist or other staff member might be the final opportunity to know where loved ones or an attorney can find a patient who’s been detained.
“If you don’t ask, then you’re definitely not going to get that information,” she said. “And that’s something that hospitalists can do.”
Of course, hospitalists also need to stand up for the patient’s health, as well, she said. If someone is about to be detained, but their removal from the hospital is inappropriate for health reasons, hospitalists have to speak up, Ms. Baldwin said.
“The physician also has a role of making sure that their health is not going to be negatively impacted by being taken into custody sooner than what would be medically prudent,” she said. “You can’t really stop ICE from doing what they’re going to do. But I think ICE would probably listen more to a physician than they would to an administrator or a nurse, honestly.”
She said that while hospitalists are not lawyers, they can let patients know that they are not required to speak with ICE officials.
“They can say they have the right to stay silent—‘you don’t have to answer questions,’” she said. “It can be as simple as that.”
In the end, by implementing clear policies, educating staff, protecting patient privacy, and ensuring ethical care delivery, hospitalists can navigate ICE-related activities while maintaining patient trust and legal compliance. As immigration policies continue to shift, hospitals must remain proactive in safeguarding the rights and well-being of all patients, regardless of their legal status.
Ms. Baldwin said the need to prepare for an increase in these visits might be daunting, but a little work in advance can make a big difference.
“Our push toward making sure that hospitals are prepared and have a plan is not necessarily to scare everyone and make everyone very nervous—it’s really to make sure that they have a little bit of control over how they respond,” she said.
She said how many visits ICE will make to hospitals is unknown.
“We don’t know whether all of this initial stuff is kind of shock and awe and to add chaos and to make people just really, really frightened, and then it’s going to trickle away, because there’s only so much staff and resources at ICE,” she said. “Hopefully, they never have to deal with it.”
Tom Collins is a freelance medical writer based in Florida. Dr. Patel is the chair of the inpatient clinical informatics council, the medical director of virtual medicine, and a hospitalist at Ballad Health System in Johnson City, Tenn. He also chairs SHM’s Health Information Technology Special Interest Group.
Reference
- Baldwin T, Meilink K. ICE at Healthcare Facilities: What Should You Do. Husch Blackwell website 2025. https://www.huschblackwell.com/newsandinsights/ice-at-healthcare-facilities-what-should-you-do
