As ICE policy shifts, NC health care workers face uncertainty

This story was first published by Anne Blythe, North Carolina Health News
February 12, 2025

As executive orders and new policy directives come out of the White House at a dizzying pace, many health care workers have found themselves in a quandary.

Within hours of President Donald Trump’s second inauguration, the Department of Homeland Security acting secretary issued a directive overturning Biden administration guidelines that established “protected areas” such as hospitals, medical facilities, churches and schools from U.S. Immigration and Customs Enforcement actions.

Now many doctors and other health care providers are uncertain what to do if immigration officers, often referred to as ICE, show up in their waiting rooms and clinics.

That question has been posed on social media, email chains, immigration law centers, law review sites, opinion pages and in discussion groups.

The topic exposed raw emotions, tears and steadfast determination at recent meetings of LATIN-19, an online gathering of health workers and community organizations that began meeting weekly in March 2020 to disseminate information to Latino communities about COVID-19.

“It feels very much like the beginning of the pandemic when there was a lot going on, a lot of fear, a lot of concern and the virus was unknown, and we were seeing our community affected,” Viviana Martinez-Bianchi, a family medicine physician at Duke, told participants during a LATIN-19 meeting last week. “So there’s a similarity to this.”

‘A moment of uncertainty’

A central principle of the Hippocratic Oath that physicians take when they receive their medical degree is to “first do no harm.” 

Just the possibility of immigration and border patrol officers taking enforcement actions in health care facilities has the potential to keep immigrants and their family members from seeking treatment, Latino and immigrant advocates say. The absence of care not only can have a pernicious effect on an individual’s health, but on the larger community as well if infectious diseases go unchecked.

There also are heightened concerns about the mental health impact of some of the political rhetoric and immigration policy changes nationally and locally.

Martinez-Bianchi, a native of Argentina, president-elect of the World Organization of Family Doctors and U.S. citizen who has emerged as a leader and ardent advocate of building bridges between marginalized communities and people in positions of power, tried to offer reassuring and motivating words during the first LATIN-19 meeting days after the first round of Trump administration directives were issued.

“Before I get started, I want to share that I speak to you in a moment of uncertainty and concern for our community, and also with an idea that we need a call for action and unity because it is certain that the recent executive orders and policy changes that were announced have profound implications for the health, especially for the health of immigrant communities,” Martinez-Bianchi said. “And as a group, we have always said, an injury to one is an injury to all.

“I know this is a difficult time,” she added.

LATIN-19 is a group that willingly acknowledges problems, then immediately shifts into action mode, looking for steps to take to combat perceived inadequacies and injustices in established systems. If new policies were deterring certain populations from seeking health care, participants asked:

• Could telehealth be used more for such things as mental health care and other wellness checks that don’t necessarily require in-person visits?
• If health care workers were uncertain how to behave if ICE showed up in waiting rooms and clinics, are there policies and laws they should brush up on to know their rights and those of their patients?
• How do obligations to immigration enforcement efforts mesh with the Health Insurance Portability and Accountability Act, or HIPAA privacy laws?

Hospitals tread carefully

Community groups have been creating “know your rights” cards and materials that can be distributed at clinics and other gathering places while health care workers try to get answers about what actions are and are not appropriate for them to take. 

“Duke Health has a long-standing commitment to protecting patient privacy under HIPAA, while following all applicable laws that govern when and how members of law enforcement are permitted access to information or clinical areas,” Duke Health officials said in a statement emailed to NC Health News. “In all circumstances, our team members are trained to implement protocols that enable the appropriate level of access when law officers present a valid search warrant or court order. These protocols are the same regardless of the law enforcement agency.”

Having law enforcement officers in health care facilities is nothing new. They have long been coming to emergency rooms and other areas if victims of violence or people in custody are there, hospital spokespeople told NC Health News.

“At UNC Health, we are committed to providing high quality, safe, and compassionate care to all patients, regardless of their background,” Alan Wolf, a UNC Health spokesman, wrote in an email to NC Health News. “Patients’ privacy and well-being are our top priorities. 

“Our policies recognize that law enforcement officers conduct their work within strict legal limits,” Wolf added. “UNC Health and other health care providers must protect patient privacy, such that any request from law enforcement is handled properly in accordance with applicable law.”

Democrats try for protections

Democratic lawmakers in the state House of Representatives introduced two bills on Monday that attempt to dissuade immigration raids in medical facilities, churches, schools, farm facilities and construction sites.

Rep. Deb Butler, a Wilmington attorney, filed House Bill 80, which covers the farm and construction site angle. Rep. Renee Price of Orange County filed the related House Bill 78 regarding clinics, churches and schools.

Price told NC Health News in an email on Tuesday that they were likely to face headwinds in the legislative process in a General Assembly that’s only one Republican vote shy of supermajorities in both chambers.

“I doubt the bill will have any headway in the legislative process,” Price said. “Yet, we are going to raise awareness of the issue.” 

Butler and Price co-wrote an op-ed that they shared with NC Health News, noting the economic impact of immigrant populations. 

Supporters of mass deportations often depict immigrant groups as strains on public systems without noting the taxes and other contributions they make in their communities.

“North Carolina’s economy depends heavily on immigrant labor, particularly in agriculture and construction,” Butler and Price wrote. “Immigrant workers, regardless of status, contribute immensely to our state’s productivity, yet they often face hostile and unjust treatment.”

The lawmakers cited statistics from a 2024 American Business Immigration Coalition report that states immigrants of working age in North Carolina without full legal status pay $772.5 million dollars in federal, state and local taxes and wield $6.4 billion dollars in spending power.

Butler and Price advocated for protected areas in North Carolina in places of worship, health clinics and hospitals, schools and daycares with children in mind.

“These institutions serve as lifelines for people of all ages and circumstances,” the lawmakers wrote in their opinion piece.

Already heightened concerns

Last year, the Republican-led General Assembly adopted legislation that requires sheriffs to work with immigration enforcement officers.

House Bill 10, or HB10 as the immigration bill is commonly called, requires the sheriffs to honor requests from federal Immigration and customs enforcement officers to detain people they want to pick up for possible deportation for up to 48 hours in their jails, even if they don’t have a warrant to detain that person after their scheduled release date.

The debate over that law created heightened fears in immigrant communities, similar to those that have been described over the past three weeks. 

There were worries then that immigrants would stop driving for fear of being pulled over and questioned by law enforcement officers even if they had proper documents. That meant fewer trips to hospitals and clinics and mounting stress that can have a negative impact on overall health. Over the past few weeks, some health care workers have reported empty waiting rooms and pregnant women missing appointments. 

As these reports come in, there’s a sense of commitment among many providers to stand together and fight for the communities and principles that drew many immigrants to this country.

“Last Sunday, I got together with the executive of the American Academy of Family Physicians, and we discussed these things,” Martinez-Bianchi said. “Despite the fear, the difficulty, the anger and the sorrow, all of this makes us be more resilient.

“And much like we overcame the pandemic — us the comunidad latina as the most seriously affected community in this country, we went from that to being the most vaccinated community in the country. We’ll get through this too.”