In a significant shift affecting health care facilities nationwide, the “sensitive locations policy,” which protected health care settings from immigration enforcement, was rescinded in January 2025. This change—described in a newly published perspective by Kaplan, Cabot, and Ubel—alters the legal landscape for institutions and clinicians, increasing the likelihood that health care professionals will encounter U.S. Immigration and Customs Enforcement officials in clinical environments.

As a result of the policy change, U.S. Immigration and Customs Enforcement (ICE) officials are no longer categorically barred from entering health care facilities. Although the change does not grant unrestricted access to all areas or patient information, the authors note that it presents new challenges for health care professionals balancing legal compliance with their duties to patients. The Fourth Amendment and the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule remain key protections: immigration officials may enter public spaces (such as lobbies) without consent but require a valid judicial warrant or exigent circumstances (such as threats to public safety) to access private areas (such as exam rooms).

Navigating Legal Requirements

Health care professionals may face increasing pressure to comply with immigration enforcement while upholding their ethical obligations to patients. Under the HIPAA Privacy Rule, clinicians are not obligated to provide protected health information (PHI) without a valid judicial warrant or subpoena. PHI includes a wide array of data, such as a patient’s name, immigration status, and hospital discharge date.

Administrative warrants issued by the Department of Homeland Security (including Forms I-200 or I-205) are not judicial warrants and do not compel the disclosure of PHI. Judicial warrants must be signed by a judge and list a state court or U.S. district court to be valid.

The authors of the perspective advise health care professionals to:

• Verify the validity of warrants with institutional legal counsel.

• Escort officials away from private areas while verifying documentation.

• Document the official’s name and identification number, the nature of the request, any actions taken, and obtain copies of any documentation provided.

The authors emphasize that clinicians should not provide information beyond the scope of a valid warrant and should avoid documenting a patient’s immigration status in medical records, as this information may be used against the patient in legal proceedings.

Institutional Policies and Best Practices

Institutions are advised to establish clear policies distinguishing public spaces (such as lobbies, parking lots, and sidewalks) from private areas (such as clinical workspaces and waiting rooms) using signage, closed or locked doors, and restricted access. Confidential information should be kept out of plain view in all areas.

The perspective authors also recommend that institutions establish a response team dedicated to managing interactions with immigration officials and ensure that legal counsel is readily available to patients. Policies should also be updated to clarify procedures when officials present requests for medical evaluations or access to patient information.

Ethical Concerns and Clinical Duties

The authors describe scenarios in which immigration officials have pressured clinicians to perform tasks that conflict with clinical best practices, such as certifying detainees’ fitness to travel for deportation, obtaining dental x-rays to estimate a detainee’s age, and force-feeding detainees engaged in hunger strikes. These practices have been condemned by medical experts and ethicists, raising serious ethical concerns.

Clinicians are advised to remain committed to their professional obligations, perform only clinically indicated evaluations and interventions, and document their medical reasons for declining nonindicated procedures.

Special Considerations: Surrogate Decision-Makers

The authors note that clinicians may face challenges contacting surrogate decision-makers for patients in ICE custody or for those whose family members have been detained or deported. Officials may delay or restrict approval for such contact, citing security concerns. To mitigate this risk, clinicians are encouraged to advise patients to complete legal documentation designating surrogate decision-makers (such as a medical power of attorney) and, when possible, to name multiple surrogates.

Barriers to Care and Telehealth Solutions

The increased presence of immigration enforcement has led many undocumented immigrants to avoid seeking health care, which the authors note poses risks to both individual and public health. They suggest offering multilingual telehealth services to help reduce barriers to care for patients who may fear in-person visits.

Conclusions

As immigration policies evolve, health care professionals may face complex legal and ethical challenges. By understanding their legal rights and those of their patients, and by working with institutions to establish robust legal and procedural safeguards, clinicians can continue caring for patients while remaining compliant with federal law.

The authors declared having no competing interests.

Source: The New England Journal of Medicine