How can we protect our patients against ICE?

[Angry Birds]

I know this forum will be hotly divided on this topic, but for those of us who are in the "F*** ICE" camp like myself, what can we do if ICE walks into the ER?

What risks do we run for non-cooperation and actively blocking these f********?

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[southerndoc]

While I'm against ICE showing up and taking a patient away, I am not going to argue with someone with a gun. If they take the patient, then they assume all liability for their medical decompensation. I will simply say they haven't been stabilized and that's as far as I'm going. If the hospital administrators want to argue with the officers with guns, then that's for them to do.

 

[DocEspana]

I know this forum will be hotly divided on this topic, but for those of us who are in the "F*** ICE" camp like myself, what can we do if ICE walks into the ER?

What risks do we run for non-cooperation and actively blocking these f********?

I never even considered this possibility and now I'm perplexed as to what I would do

 

[AlmostAnMD]

I never even considered this possibility and now I'm perplexed as to what I would do

Stonewall if it's staff

If it's a patient they're reducing your census

Personally lead them to room in that case

 

[Siggy]

"I'm sorry, I can't release any information without a signed warrant."

"Let me call the nursing supervisor."

Finally, hope they drag my butt out of the hospital so I can get a payout like nurse Alex Wubbels and the illegal DUI blood draw.

 

[DocEspana]

Stonewall if it's staff

If it's a patient they're reducing your census

Personally lead them to room in that case

I constantly remind my nurses that every time their sphincter clenches over an AMA, a LWBS, or an absconded (non-psych) patient.... "Its a disposition".

They want to snatch a patient? I would be logically consistent to just shrug and go "It's a disposition."

I do think that I'm more intellectually aligned with this:

"I'm sorry, I can't release any information without a signed warrant."

"Let me call the nursing supervisor."

Finally, hope they drag my butt out of the hospital so I can get a payout like nurse Alex Wubbels and the illegal DUI blood draw.

I want that lawsuit payout.

 

[BoardingDoc]

I know this forum will be hotly divided on this topic, but for those of us who are in the "F*** ICE" camp like myself, what can we do if ICE walks into the ER?

What risks do we run for non-cooperation and actively blocking these f********?

Call AOD. This is their problem. That's also likely as much of a delay tactic as you can employ without potentially getting yourself into hot water.

Also, the comment of "I can't release any information without a signed warrant" is only true regarding specific medical information. HIPAA does not prevent you from telling a LEO whether or not a patient is currently in the department if the LEO informs you that they are looking for them.

Source: https://www.hhs.gov/hipaa/for-profe...close-to-law-enforcement-officials/index.html

All of that said, I would just punt this to the AOD 100% of the time. "Let me call my administrator who can help you." Walk away, see next patient.

 

[WhatJobDoIPick]

Who is protecting us from workplace violence, CMS cuts and burnout?

That's where my caring ends.

 

[EctopicFetus]

Yeah. The hospital can deal with this. Im a doctor. Ill do doctor things. I am not looking to get arrested, I am not looking for legal trouble. ICE wants to know where Patient X is.. ask the charge nurse, ICE wants to take the patient from the ED before I medically eval them? Ill let them know I will document that I was unable to finish my assessment etc.. that being said my very long experience with LE is they have 0 interest in any medical risk.

So i think the answer to the question depends on what is being asked. If they want to know if Patient X is in the ED, ill point them to the charge nurse. Regardless of your feelings on the immigration topic, I dont think the ED is the place to hash it out. I am looking for dispos. If the patient is not at risk medically I am not sure I have much else to offer. I am sure there are some exceptions where I would feel differently but when i trained in Southern AZ we had tons of patients brought in by border patrol. I feel for their plight as an immigrant myself then again, im an EM doc not an immigration attorney or diplomat or any of 100 other jobs that can help these people.

 

[TeddyBoomBoom]

Call AOD. This is their problem. That's also likely as much of a delay tactic as you can employ without potentially getting yourself into hot water.

Also, the comment of "I can't release any information without a signed warrant" is only true regarding specific medical information. HIPAA does not prevent you from telling a LEO whether or not a patient is currently in the department if the LEO informs you that they are looking for them.

Source: https://www.hhs.gov/hipaa/for-profe...close-to-law-enforcement-officials/index.html

All of that said, I would just punt this to the AOD 100% of the time. "Let me call my administrator who can help you." Walk away, see next patient.

^^^ this is the answer.

I’m certainly not going to get into a pissing match with law enforcement, but I’m also not an officer of the state and have no obligations to help.

Just escalate to admin and continue working.

 

[JacobMcCandles]

I think the chance this happens is exceedingly small. I’d document whatever I needed to and move on.

 

[Tiger26]

I think the baseline question is are you protecting any other patients from law enforcement for their commission of a crime?

 

[Janders]

Suggestion from my state’s attorney general for front line HcW—

A healthcare facility may also distribute clear procedures to staff members about what to do if an ICE official or other law enforcement officer requests access to a patient or a patient care area. A healthcare facility may want to include the following steps in any such procedures:

• First, ask the officer for his or her name, identification number, and the name of the agency with which he or she is affiliated;
• Second, ask the officer if they have a judicial warrant or court order, and if so, ask for a copy of the document. Without a court order or warrant signed by a judge, immigration officers cannot compel a healthcare provider or their staff to comply with their requests;
• Third, inform the officer that you are not attempting to obstruct their actions, but that you are not authorized to respond to the request and need to contact the appropriate point person before you can provide access; and
  Fourth, ask the officer to wait outside while you contact your legal counsel
  r other appropriate point person.

 

[Janders]

Alternative recommendation is the review the excellent Shut the F*** Up Friday script from the Pot Brothers at Law, which is generally applicable to interactions with law enforcement where you don’t want to speak…

 

[Emapp20177]

Our job doesn't change one bit. I'm not sure why OP is even asking this question. Do you wish to actively obstruct local police activity as well? Stay in your lane. Evaluate and treat for medical emergencies. That's your job. You place yourself at risk "actively blocking these xyzs." It's call obstruction of justice.

 

[Janders]

Our job doesn't change one bit. I'm not sure why OP is even asking this question. Do you wish to actively obstruct local police activity as well? Stay in your lane. Evaluate and treat for medical emergencies. That's your job. You place yourself at risk "actively blocking these xyzs." It's call obstruction of justice.

I think there is concern that ICE will act beyond currently understood constitutional / legal principles, and that while HCW don’t want to obstruct justice, they also may not want to eagerly hand over a list of all immigrants in the hospital to a couple of men in black clothes with a badge.

I’m a big constitution / rights / process guy, and the conversation is very similar to the question of what to do if the police show up at your door and ask xyz. I’m not interested in obstructing justice, but I’m also not interested in accidental self-incrimination etc.

There is actually a lot of nuance to the discussion of warrants, so the basic concept that you should defer answering questions to the hospital admin on duty / hospital legal is very reasonable and NOT obstruction


[below from the MA attorney general]
ICE Administrative Removal Warrants (Form I-200) or Arrest Warrants (Form I-
205) authorize ICE officers to arrest a person suspected of violating the immigration laws. These are not warrants within the meaning of the Fourth Amendment to the U.S. Constitution, are not signed by a judge or magistrate judge and are not based on a showing of probable cause of a criminal offense. These warrants do not require healthcare providers to grant ICE officers access to a facility's non-public areas.


Federal Arrest Warrants (Form AO 442) or Search and Seizure Warrants (Form AO
93) are issued by a federal court judge or magistrate judge based on a finding of probable cause and authorize the search and seizure of property in a specified location or the arrest of a person named in the warrant, including in non-public areas. Prompt compliance with these warrants is usually required. If feasible, a healthcare provider should review the document and consult with legal counsel.

 

[WhatJobDoIPick]

Our job doesn't change one bit. I'm not sure why OP is even asking this question. Do you wish to actively obstruct local police activity as well? Stay in your lane. Evaluate and treat for medical emergencies. That's your job. You place yourself at risk "actively blocking these xyzs." It's call obstruction of justice.

It's enigmatic of the typical clueless EM social justice warrior who bill 2% 99291 by but want to fight ICE to protect a criminal.

 

[gruemd]

It's enigmatic of the typical clueless EM social justice warrior who bill 2% 99291 by but want to fight ICE to protect a criminal.

What a nuanced and useful response.

If a patient is under my care, they are under my care. Unless someone comes along and supersedes that responsibility of care or the patient chooses to terminate that relationship, they remain under my care. When police show up with a patient and tap their toes and ask "how much longer?" 20 times, I say however long it takes to rule out any emergent pathology and stabilize the patient. If they say things like "well call us when you're discharging them so we can pick them up" I say, no and tell them to stick around if they care that much. If someone without the need to know (or constitutional authority to know) shows up asking if a patient is there, I'll do what was suggested above and make it an admin problem, but just as my job isn't to be law enforcement, it also isn't my job to lick their boots and help further the erosion of US constitutional rights either.

 

[WhatJobDoIPick]

What a nuanced and useful response.

If a patient is under my care, they are under my care. Unless someone comes along and supersedes that responsibility of care or the patient chooses to terminate that relationship, they remain under my care. When police show up with a patient and tap their toes and ask "how much longer?" 20 times, I say however long it takes to rule out any emergent pathology and stabilize the patient. If they say things like "well call us when you're discharging them so we can pick them up" I say, no and tell them to stick around if they care that much. If someone without the need to know (or constitutional authority to know) shows up asking if a patient is there, I'll do what was suggested above and make it an admin problem, but just as my job isn't to be law enforcement, it also isn't my job to lick their boots and help further the erosion of US constitutional rights either.

Right. Agree.

Doesn't differ from any other criminal.

 

[Mount Asclepius]

I don’t understand the various confrontational approaches expressed in this thread. Our jobs overlap more than most with law enforcement. We can be collegial with them. Ultimately we don’t enforce the law. If law enforcement of any type practices improper enforcement then that’s on them. If they ask a question that you don’t know then contact the nursing supervisor, AOC or risk management for assistance. HIPAA does have carve outs for law enforcement. It is worth familiarizing yourself with that. Otherwise I don’t think this needs to be overly complicated. Stay collegial and some of these issues probably aren’t your hill to die on.

 

[JacobMcCandles]

I think there is concern that ICE will act beyond currently understood constitutional / legal principles, and that while HCW don’t want to obstruct justice, they also may not want to eagerly hand over a list of all immigrants in the hospital to a couple of men in black clothes with a badge.

Do you HONESTLY think (not in a ‘but there’s still a 0.000000001% chance it COULD happen’) ICE is going to show up and ask a hospital for a list of illegal immigrants? I mean, do hospitals even know the immigration status of all its patients? I typically don’t know the immigration status of anyone I see.

 

[WhatJobDoIPick]

I don’t understand the various confrontational approaches expressed in this thread. Our jobs overlap more than most with law enforcement. We can be collegial with them. Ultimately we don’t enforce the law. If law enforcement of any type practices improper enforcement then that’s on them. If they ask a question that you don’t know then contact the nursing supervisor, AOC or risk management for assistance. HIPAA does have carve outs for law enforcement. It is worth familiarizing yourself with that. Otherwise I don’t think this needs to be overly complicated. Stay collegial and some of these issues probably aren’t your hill to die on.

Admin types and nurses wanted to run the hospital, well now here's their chance.

 

[gruemd]

I don’t understand the various confrontational approaches expressed in this thread. Our jobs overlap more than most with law enforcement. We can be collegial with them. Ultimately we don’t enforce the law. If law enforcement of any type practices improper enforcement then that’s on them. If they ask a question that you don’t know then contact the nursing supervisor, AOC or risk management for assistance. HIPAA does have carve outs for law enforcement. It is worth familiarizing yourself with that. Otherwise I don’t think this needs to be overly complicated. Stay collegial and some of these issues probably aren’t your hill to die on.

To be clear, I am collegial with law enforcement anytime I interact with them. I don't overstep my boundaries. I don't think it's complicated either.

But I do disagree with the characterization of some of our EM colleagues on how their differing views on a complex social issue make them clueless, or otherwise less-than.

 

[Janders]

Do you HONESTLY think (not in a ‘but there’s still a 0.000000001% chance it COULD happen’) ICE is going to show up and ask a hospital for a list of illegal immigrants? I mean, do hospitals even know the immigration status of all its patients? I typically don’t know the immigration status of anyone I see.

Agree that particular notion is unlikely but not impossible. More likely they’d want a list of all patients, cross referencing a list they have, ask for Mr XYZ, etc. Most likely they are coming for a particular individual, which may very well be a valid and legal action even if the location is suboptimal.

There are a lot of EDs and a lot of ED Docs out there. Doubtful many of us will have this interaction but I bet someone will.

Regardless of the ICE particulars, I have twice in my career been asked by law enforcement to do clearly illegal / unconstitutional / wrong actions and my refusal caused brief kerfuffles. I always want to have collegial interactions with law enforcement and have no interest in obstructing justice. Doesn’t mean I say yes to every single request though!

 

[JacobMcCandles]

Agree that particular notion is unlikely but not impossible. More likely they’d want a list of all patients, cross referencing a list they have, ask for Mr XYZ, etc. Most likely they are coming for a particular individual, which may very well be a valid and legal action even if the location is suboptimal.

There are a lot of EDs and a lot of ED Docs out there. Doubtful many of us will have this interaction but I bet someone will.

Regardless of the ICE particulars, I have twice in my career been asked by law enforcement to do clearly illegal / unconstitutional / wrong actions and my refusal caused brief kerfuffles. I always want to have collegial interactions with law enforcement and have no interest in obstructing justice. Doesn’t mean I say yes to every single request though!

It sounds like we agree the situation is unlikely.

I don’t think this is anything to be concerned about and should be handled like any other situation with regards to law enforcement coming to the ED in search of someone, which is, it isn’t my job. I’d refer them on.

I think the OP actively blocking ICE is just as stupid as a physician calling ICE because a patient is illegal. I have zero problem with ICE doing their job but the chances it concerns me at is about 0%.

 

[southerndoc]

I think there is concern that ICE will act beyond currently understood constitutional / legal principles, and that while HCW don’t want to obstruct justice, they also may not want to eagerly hand over a list of all immigrants in the hospital to a couple of men in black clothes with a badge.

I’m a big constitution / rights / process guy, and the conversation is very similar to the question of what to do if the police show up at your door and ask xyz. I’m not interested in obstructing justice, but I’m also not interested in accidental self-incrimination etc.

There is actually a lot of nuance to the discussion of warrants, so the basic concept that you should defer answering questions to the hospital admin on duty / hospital legal is very reasonable and NOT obstruction


[below from the MA attorney general]
ICE Administrative Removal Warrants (Form I-200) or Arrest Warrants (Form I-
205) authorize ICE officers to arrest a person suspected of violating the immigration laws. These are not warrants within the meaning of the Fourth Amendment to the U.S. Constitution, are not signed by a judge or magistrate judge and are not based on a showing of probable cause of a criminal offense. These warrants do not require healthcare providers to grant ICE officers access to a facility's non-public areas.


Federal Arrest Warrants (Form AO 442) or Search and Seizure Warrants (Form AO
93) are issued by a federal court judge or magistrate judge based on a finding of probable cause and authorize the search and seizure of property in a specified location or the arrest of a person named in the warrant, including in non-public areas. Prompt compliance with these warrants is usually required. If feasible, a healthcare provider should review the document and consult with legal counsel.

The very last thing I'm going to do is debate what type of warrant an ICE agent has. LOL

What would I do if a family member showed up and kidnapped a patient? Call security. The same thing will occur if an ICE agent shows up to take a patient. I will call security.

 

[Tenk]

I’d go for some old school Homer Simpson and have someone else deal with it.

 

[RustedFox]

I'm surprised the left doesnt love ICE.

We here in the US are finally becoming more like those Nordic paradises that the left extols for their "free" everything.

Try screwing around with an expired visa in Denmark, if they even gave you one. Maybe you came in illegally.

You'll quickly meet Hans and Fritz, who are here with their Steyr AUGs to help you get on the right flight or train out of there.

They -enforce- their border security.

Wild, I know.

 

[xaelia]

A bit of a strange premise for a thread.

There are certainly hospitals (say, like LBJ in Houston where I used to work) where a nontrivial number of presentations would be from noncitizens.

I can imagine a scenario in which immigration agents wanted to remove someone prior to the conclusion of their medical episode of care; if reason failed, the administrative chain of command exists for this purpose.

Physically obstructing removal may result in your own arrest; I wouldn't begrudge anyone their principles if they chose to do so, but I would also find it a relatively ineffective act, unfortunately.

 

[Pudortu]

I'm surprised the left doesnt love ICE.

We here in the US are finally becoming more like those Nordic paradises that the left extols for their "free" everything.

Try screwing around with an expired visa in Denmark, if they even gave you one. Maybe you came in illegally.

You'll quickly meet Hans and Fritz, who are here with their Steyr AUGs to help you get on the right flight or train out of there.

They -enforce- their border security.

Wild, I know.

I hesitated to comment on this thread as an immigrant myself.
But did these people think there wouldn't be consequences to their actions?
That being said, I pity the hard working immigrant trying to make a better life for themselves and their family. I just won't stand in the way of a LEO doing their job. Call admin on call and let them deal with it.

 

[RustedFox]

I hesitated to comment on this thread as an immigrant myself.
But did these people think there wouldn't be consequences to their actions?
That being said, I pity the hard working immigrant trying to make a better life for themselves and their family. I just won't stand in the way of a LEO doing their job. Call admin on call and let them deal with it.

I'll also bet you came here quite legally and documented.

BestBuddy from residency and father to my Goddaughter is an immigrant that waited a looooong time to come legally.

He's a bit upset that people who don't do it the right way are just like, doing whatever they want and getting cash money honey for it.

 

[HoosierdaddyO]

Ice Agent: we are look for Mr. Guacamole

Me: No Hablo ingles!

As we then both awkwardly stare at each other.

 

[TooMuchResearch]

I think the baseline question is are you protecting any other patients from law enforcement for their commission of a crime?

You mean like the patients law enforcement drive to my ED for evaluation and refuse to turn off body cam and leave the room when I evaluate the patient but as soon as I'm done ask someone else to sit in the room so they can go to their car?

Yes. Frequently.

 

[southerndoc]

Ice Agent: we are look for Mr. Guacamole

Me: No Hablo ingles!

As we then both awkwardly stare at each other.

Until he says "show me your papers" as he slaps the wrist bracelets on.

 

[Rekt]

I know this forum will be hotly divided on this topic, but for those of us who are in the "F*** ICE" camp like myself, what can we do if ICE walks into the ER?

What risks do we run for non-cooperation and actively blocking these f********?

As much as I despise President Musk and First Lady Trump, this isn’t our fight. Document accordingly and move on.

 

[southerndoc]

I'll chime in with the friendly limit the political banter to keep this focused reminder. If we can't behave ourselves, the thread will get locked and/or moved to the netherlands.

 

[Siggy]

I think the baseline question is are you protecting any other patients from law enforcement for their commission of a crime?

If the police don't have a warrant signed by a judge, then they can go pound sand. They obviously don't have enough for a patient to be considered a proper suspect/probable cause.

...or was Alex Wubbles wrong for protecting the victim of a car crash from having his blood illegally seized?

 

[Siggy]

Alternative recommendation is the review the excellent Shut the F*** Up Friday script from the Pot Brothers at Law, which is generally applicable to interactions with law enforcement where you don’t want to speak…

How about the classic, "Don't Talk to the Police" video?

 

[Siggy]

Our job doesn't change one bit. I'm not sure why OP is even asking this question. Do you wish to actively obstruct local police activity as well? Stay in your lane. Evaluate and treat for medical emergencies. That's your job. You place yourself at risk "actively blocking these xyzs." It's call obstruction of justice.

Invoking your rights isn't obstruction of justice, regardless of what that idiot Tom Homan believes.

 

[WhatJobDoIPick]

I'm amazed at the stand EPs are willing to take for this but not for their own paychecks.

 

[RustedFox]

Invoking your rights isn't obstruction of justice, regardless of what that idiot Tom Homan believes.

Our rights apply to our citizens.
We're talking about non-citizens entering the nation illegally.
They don't have the rights that we do.

 

[JacobMcCandles]

I'm amazed at the stand EPs are willing to take for this but not for their own paychecks.

It’s all virtue signaling for a situation they know they won’t find themselves in.

 

[NYEMMED]

Why would I risk an obstruction of justice charge for a person possibly guilty of a misdemeanor or felony???

 

[Janders]

Our rights apply to our citizens.
We're talking about non-citizens entering

Our rights apply to our citizens.
We're talking about non-citizens entering the nation illegally.
They don't have the rights that we do.

the nation illegally.
They don't have the rights that we do.

Wrong! While they do lack some of our rights (voting) even undocumented immigrants have the rights which are relevant to this thread and delineated in the bill of rights—

• Due process:
  
  
• Equal protection
  
  
• Freedom from unreasonable searches and seizures

 

[RustedFox]

Wrong! While they do lack some of our rights (voting) even undocumented immigrants have the rights which are relevant to this thread and delineated in the bill of rights—

• Due process:
  
  
• Equal protection
  
  
• Freedom from unreasonable searches and seizures

Nah.
Take those rights away.

 

[Janders]

Nah.
Take those rights away.

I mean, the supreme court may in the future... but current case law is pretty explicit on the subject. The children also have a right to public school education, etc...

 

[RustedFox]

I mean, the supreme court may in the future... but current case law is pretty explicit on the subject. The children also have a right to public school education, etc...

!Afuera!

 

[Birdstrike]

Choose the relationship you’re going to have with the patient:

1) Defense lawyer

2) Judge

3) Juror

4) Doctor

You can only be one.

 

[WilcoWorld]

I can not protect my patients from ICE or other government agencies, but I think an entirely appropriate question for an Emergency Physician to ask is: How can I avoid participating in the infringement of people's rights without getting myself arrested?

This is a question you do not want to try and answer on shift. I know the answer where I work, but I won't try to give a blanket answer, because there is variation from one state to the next.

 

[Siggy]

Our rights apply to our citizens.
We're talking about non-citizens entering the nation illegally.
They don't have the rights that we do."

"The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized."

"No person shall be held to answer for a capital, or otherwise infamous crime, unless on a presentment or indictment of a Grand Jury, except in cases arising in the land or naval forces, or in the Militia, when in actual service in time of War or public danger; nor shall any person be subject for the same offence to be twice put in jeopardy of life or limb; nor shall be compelled in any criminal case to be a witness against himself, nor be deprived of life, liberty, or property, without due process of law; nor shall private property be taken for public use, without just compensation."

So illegals aren't people?