clinic

In recent months, federal agents camped out in the lobby of a Southern California hospital, guarded detained patients — sometimes shackled — in hospital rooms, and chased an immigrant landscaper into a surgical center.

U.S. Immigration and Customs Enforcement agents also have shown up at community clinics. Health providers say officers tried to enter a parking lot hosting a mobile clinic, waved a machine gun in the faces of clinicians serving the homeless, and hauled a passerby into an unmarked car outside a community health center.

In response to such immigration enforcement activity in and around clinics and hospitals, Gov. Gavin Newsom last month signed SB 81, which prohibits medical establishments from allowing federal agents without a valid search warrant or court order into private areas, including places where patients receive treatment or discuss health matters.

But while the bill received broad support from medical groups, health care workers and immigrant rights advocates, legal experts say California can’t stop federal authorities from carrying out duties in public places like hospital lobbies and general waiting areas, parking lots and surrounding neighborhoods — places where recent ICE activities sparked outrage and fear. Previous federal restrictions on immigration enforcement in or near sensitive areas, including health care establishments, were rescinded by the Trump administration in January.

“The issue that states encounter is the supremacy clause,” said Sophia Genovese, a supervising attorney and clinical teaching fellow at Georgetown Law. She said the federal government has the right to conduct enforcement activities, and there are limits to what the state can do to stop them.

California’s law designates a patient’s immigration status and birthplace as protected information, which like medical records cannot be disclosed to law enforcement without a warrant or court order. And it requires health care facilities to have clear procedures for handling requests from immigration authorities, including training staff to immediately notify a designated administrator or legal counsel if agents ask to enter a private area or review patient records.

Several other Democratic-led states also have taken up legislation to protect patients at hospitals and health centers. In May, Colorado Gov. Jared Polis signed the Protect Civil Rights Immigration Status bill, which penalizes hospitals for unauthorized sharing of information about people in the country illegally and bars ICE agents from entering private areas of health care facilities without a judicial warrant. In Maryland, a law requiring the attorney general to create guidance on keeping ICE out of health care facilities went into effect in June. New Mexico instituted new patient data protections, and Rhode Island prohibited health care facilities from asking patients about their immigration status.

Republican-led states have aligned with federal efforts to prevent health care spending on immigrants without legal authorization. Such immigrants are not eligible for comprehensive Medicaid coverage, but states do bill the federal government for emergency care in certain cases. Under a law that took effect in 2023, Florida requires hospitals that accept Medicaid to ask about a patient’s legal status. In Texas, hospitals now have to report how much they spend on care for immigrants without legal authorization.

“Texans should not have to shoulder the burden of financially supporting medical care for illegal immigrants,” Gov. Greg Abbott said in issuing his executive order last year.

California’s efforts to rein in federal enforcement come as the state, where more than a quarter of residents are foreign-born, has become a target of President Trump’s immigration crackdown. Newsom signed SB 81 as part of a bill package prohibiting immigration agents from entering schools without a warrant, requiring law enforcement officers to identify themselves, and banning officers from wearing masks. SB 81 was passed on a party-line vote with no formal opposition.

“We’re not North Korea,” Newsom said during a September bill-signing ceremony. “We’re pushing back against these authoritarian tendencies and actions of this administration.”

Some supporters of the bill and legal experts said California’s law can prevent ICE from violating existing patient privacy rights. Those include the Fourth Amendment, which prohibits searches without a warrant in places where people have a reasonable expectation of privacy. Valid warrants must be issued by a court and signed by a judge. But ICE agents frequently use administrative warrants to try to gain access to private areas they don’t have the authority to enter, Genovese said.

“People don’t always understand the difference between an administrative warrant, which is a meaningless piece of paper, versus a judicial warrant that is enforceable,” Genovese said. Judicial warrants are rarely issued in immigration cases, she added.

The Department of Homeland Security said it won’t abide by California’s mask ban or identification requirements for law enforcement officers, slamming them as unconstitutional. The department did not respond to a request for comment on the state’s new rules for health care facilities, which went into immediate effect.

Tanya Broder, a senior counsel with the National Immigration Law Center, said immigration arrests at health care facilities appear to be relatively rare. But the federal decision to rescind protections around sensitive areas, she said, “has generated fear and uncertainty across the country.” Many of the most high-profile news reports of immigration agents at health care facilities have been in California, largely involving detained patients brought in for care.

The California Nurses Assn., the state’s largest nurses union, was a co-sponsor of the bill and raised concerns about the treatment of Milagro Solis-Portillo, a 36-year-old Salvadoran woman who was under round-the-clock ICE surveillance at Glendale Memorial Hospital over the summer.

Nurses say immigration agents brought a patient to California Hospital Medical Center in Los Angeles and stayed in the patient’s room for almost a week.

(Mel Melcon/Los Angeles Times)

Union leaders also condemned the presence of agents at California Hospital Medical Center south of downtown Los Angeles. According to Anne Caputo-Pearl, a labor and delivery nurse and the chief union representative at the hospital, agents brought in a patient on Oct. 21 and remained in the patient’s room for almost a week. The Los Angeles Times reported that a TikTok streamer, Carlitos Ricardo Parias, was taken to the hospital that day after he was wounded during an immigration enforcement operation in South Los Angeles.

The presence of ICE was intimidating for nurses and patients, Caputo-Pearl said, and prompted visitor restrictions at the hospital. “We want better clarification,” she said. “Why is it that these agents are allowed to be in the room?”

Hospital and clinic representatives, however, said they already are following the law’s requirements, which largely reinforce extensive guidance put out by state Attorney General Rob Bonta in December.

Community clinics throughout Los Angeles County, which serve more than 2 million patients a year, including a large portion of immigrants, have been implementing the attorney general’s guidelines for months, said Louise McCarthy, president and chief executive of the Community Clinic Assn. of Los Angeles County. She said the law should help ensure uniform standards across health facilities that clinics refer out to and reassure patients that procedures are in place to protect them.

Still, it can’t prevent immigration raids from happening in the broader community, which have made some patients and even health workers afraid to venture outside, McCarthy said. Some incidents have occurred near clinics, including an arrest of a passerby outside a clinic in East Los Angeles, which a security guard caught on video, she said.

“We’ve had clinic staff say, ‘Is it safe for me to go out?’” she said.

At St. John’s Community Health, a network of 24 community health centers and five mobile clinics in South Los Angeles and the Inland Empire, chief executive Jim Mangia agreed the new law can’t prevent all immigration enforcement activity, but said it gives clinics a tool to push back with if agents show up, something his staff has had to do.

Mangia said St. John’s staff had two encounters with immigration agents over the summer. In one, he said, staff stopped armed officers from entering a gated parking lot at a drug and alcohol recovery center where doctors and nurses were seeing patients at a mobile health clinic.

Another occurred in July, when immigration agents descended upon MacArthur Park on horses and in armored vehicles, in a show of force by the Trump administration. Mangia said masked officers in full tactical gear surrounded a street medicine tent where St. John’s providers were tending to homeless patients, screamed at staff to get out and pointed a gun at them. The providers were so shaken by the episode, Mangia said, that he had to bring in mental health professionals to help them feel safe going back out on the street.

A DHS spokesperson told CalMatters that in the rare instance when agents enter certain sensitive locations, officers would need “secondary supervisor approval.”

Since then, St. John’s doubled down on providing support and training to staff and offered patients afraid to go out the option of home medical visits and grocery deliveries. Patient fears and ICE activity have decreased since the summer, Mangia said, but with DHS planning to hire an additional 10,000 ICE agents, he doubts that will last.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Pregnancy centers in the U.S. that discourage women from getting abortions have been adding more medical services — and could be poised to expand further.

The expansion — including testing and treatment for sexually transmitted infections (STIs) and even providing primary medical care — has been unfolding for years. It gained steam after the Supreme Court overturned Roe vs. Wade three years ago, clearing the way for states to ban abortion.

The push could get more momentum with Planned Parenthood closing some clinics and considering shutting others after changes to Medicaid. Planned Parenthood is not just the nation’s largest abortion provider, but also offers cancer screenings, sexually transmitted infection testing and treatment, and other reproductive health services.

“We ultimately want to replace Planned Parenthood with the services we offer,” said Heather Lawless, founder and director of Reliance Center in Lewiston, Idaho. She said about 40% of patients at the antiabortion center are there for reasons unrelated to pregnancy, including some who use the nurse practitioner as a primary caregiver.

The changes have frustrated abortion rights groups, who, in addition to opposing the centers’ antiabortion messaging, say they lack accountability; refuse to provide birth control; and offer only limited ultrasounds that cannot be used for diagnosing fetal anomalies because the people conducting them don’t have that training. A growing number also offer unproven abortion-pill reversal treatments.

Because most of the centers don’t accept insurance, the federal law restricting release of medical information doesn’t apply to them, though some say they follow it anyway. They also don’t have to follow standards required by Medicaid or private insurers, though those offering certain services generally must have medical directors who comply with state licensing requirements.

“There are really bedrock questions about whether this industry has the clinical infrastructure to provide the medical services it’s currently advertising,” said Jennifer McKenna, a senior advisor for Reproductive Health and Freedom Watch, a project funded by liberal policy organizations that researches the pregnancy centers.

Post-Roe world opened new opportunities

Perhaps best known as “crisis pregnancy centers,” these mostly privately funded and religiously affiliated centers were expanding services such as diaper banks ahead of the Supreme Court’s 2022 Dobbs vs. Jackson Women’s Health Organization ruling, which overturned Roe.

As abortion bans kicked in, the centers expanded medical, educational and other programs, said Moira Gaul, a scholar at the Charlotte Lozier Institute, the research arm of SBA Pro-Life America. “They are prepared to serve their communities for the long term,” she said in a statement.

In Sacramento, for instance, Alternatives Pregnancy Center in the last two years has added family practice doctors, a radiologist and a specialist in high-risk pregnancies, along with nurses and medical assistants. Alternatives — an affiliate of Heartbeat International, one of the largest associations of pregnancy centers in the U.S. — is some patients’ only health provider.

When the Associated Press asked to interview a patient who had received only non-pregnancy services, the clinic provided Jessica Rose, a 31-year-old woman who took the rare step of detransitioning after spending seven years living as a man, during which she received hormone therapy and a double mastectomy.

For the last two years, she’s received all her medical care at Alternatives, which has an OB-GYN who specializes in hormone therapy. Few, if any, pregnancy centers advertise that they provide help with detransitioning. Alternatives has treated four similar patients over the last year, though that’s not its main mission, director Heidi Matzke said.

“APC provided me a space that aligned with my beliefs as well as seeing me as a woman,” Rose said. She said other clinics “were trying to make me think that detransitioning wasn’t what I wanted to do.”

Pregnancy centers expand as health clinics decline

As of 2024, more than 2,600 antiabortion pregnancy centers operated in the U.S., up 87 from 2023, according to the Crisis Pregnancy Center Map, a project led by University of Georgia public health researchers who are concerned about aspects of the centers. According to the Guttmacher Institute, 765 clinics offered abortions last year, down more than 40 from 2023.

Over the years, pregnancy centers have received a boost in taxpayer funds. Nearly 20 states, largely Republican-led, now funnel millions of public dollars to these organizations. Texas alone sent $70 million to pregnancy centers this fiscal year, while Florida dedicated more than $29 million for its “Pregnancy Support Services Program.”

This boost in resources is unfolding as Republicans have barred Planned Parenthood from receiving Medicaid funds under the tax and spending law President Trump signed in July. While federal law already blocked the use of taxpayer funds for most abortions, Medicaid reimbursements for other health services were a big part of Planned Parenthood’s revenue.

Planned Parenthood said its affiliates could be forced to close up to 200 clinics.

Some already had closed or reorganized. They have cut abortion in Wisconsin and eliminated Medicaid services in Arizona. An independent group of clinics in Maine stopped primary care for the same reason. The uncertainty is compounded by pending Medicaid changes expected to result in more uninsured Americans.

Some abortion rights advocates worry that will mean more healthcare “deserts” where the pregnancy centers are the only option for more women.

Kaitlyn Joshua, a founder of abortion rights group Abortion in America, lives in Louisiana, where Planned Parenthood closed its clinics in September.

She’s concerned that women seeking health services at pregnancy centers as a result of those closures won’t get what they need. “Those centers should be regulated,” she said. “They should be providing information which is accurate, rather than just getting a sermon that they didn’t ask for.”

Thomas Glessner, founder and president of the National Institute of Family and Life Advocates, a network of 1,800 centers, said the centers do have government oversight through their medical directors. “Their criticism,” he said, “comes from a political agenda.”

In recent years, five Democratic state attorneys general have issued warnings that the centers, which advertise to people seeking abortions, don’t provide them and don’t refer patients to clinics that do. And the Supreme Court has agreed to consider whether a state investigation of an organization that runs centers in New Jersey stifles its free speech.

Different services than Planned Parenthood

Choices Medical Services in Joplin, Mo., where the Planned Parenthood clinic closed last year, moved from focusing solely on discouraging abortion to a broader sexual health mission about 20 years ago when it began offering STI treatment, said its executive director, Karolyn Schrage.

The center, funded by donors, works with law enforcement in places where authorities may find pregnant adults, according to Schrage and Arkansas State Police.

Schrage estimates that more than two-thirds of its work isn’t related to pregnancy.

Hayley Kelly first encountered Choices volunteers in 2019 at a regular weekly dinner they brought to dancers at the strip club where she worked. Over the years, she went to the center for STI testing. Then in 2023, when she was uninsured and struggling with drugs, she wanted to confirm a pregnancy.

She anticipated the staff wouldn’t like that she was leaning toward an abortion, but she says they just answered questions. She ended up having that baby and, later, another.

“It’s amazing place,” Kelly said. “I tell everybody I know, ‘You can go there.’”

The center, like others, does not provide contraceptives — standard offerings at sexual health clinics that experts say are best practices for public health.

“Our focus is on sexual risk elimination,” Schrage said, “not just reduction.”

Mulvihill and Kruesi write for the Associated Press.

SACRAMENTO — Responding to the Trump administration’s aggressive and unceasing immigration raids in Southern California, state lawmakers this week began strengthening protections for immigrants in schools, hospitals and other areas targeted by federal agents.

The Democratic-led California Legislature is considering nearly a dozen bills aimed at shielding immigrants who are in the country illegally, including helping children of families being ripped apart in the enforcement actions.

“Californians want smart, sensible solutions and we want safe communities,” said Assemblymember Christopher Ward (D-San Diego). “They do not want peaceful neighbors ripped out of schools, ripped out of hospitals, ripped out of their workplaces.”

Earlier this week, lawmakers passed two bills focused on protecting schoolchildren.

Senate Bill 98, authored by Sen. Sasha Renée Peréz (D-Alhambra), would require school administrators to notify families and students if federal agents conduct immigration operations on a K-12 or college campus.

Legislation introduced by Assemblymember Al Muratsuchi (D-Rolling Hills Estates), AB 49, would bar immigration agents from nonpublic areas of a school unless they had a judicial warrant or court order. It also would bar school districts from providing information about pupils, their families, teachers and school employees to immigration authorities without a warrant.

A separate bill by Sen. Jesse Arreguín (D-Berkeley), SB 81, would bar healthcare officials from disclosing a patient’s immigration status or birthplace, or giving access to nonpublic spaces in hospitals and clinics, to immigration authorities without a search warrant or court order.

All three bills now head to Gov. Gavin Newsom for his consideration. If signed into law, the legislation would take effect immediately.

The school-related bills, said L.A. school board member Rocio Rivas, provide “critical protections for students, parents and families, helping ensure schools remain safe spaces where every student can learn and thrive without fear.”

Federal immigration agents have recently detained several 18-year-old high school students, including Benjamin Marcelo Guerrero-Cruz, who was picked up last month while walking his dog a few days before he started his senior year at Reseda Charter High School.

Most Republican legislators voted against the bills, but Peréz’s measure received support from two Republican lawmakers, Assemblymember Juan Alanis (R-Modesto) and state Sen. Rosilicie Ochoa Bogh (R-Yucaipa). Muratsuchi’s had support from six Republicans.

“No person should be able to go into a school and take possession of another person’s child without properly identifying themselves,” Sen. Shannon Grove (R-Bakersfield) said before voting to support the bill.

The healthcare bill follows a surge in cancellations for health appointments as immigrants stay home, fearing that if they go to a doctor or to a clinic, they could be swept up in an immigration raid.

California Nurses Assn. President Sandy Reding said that federal agents’ recent raids have disregarded “traditional safe havens” such as clinics and hospitals, and that Newsom’s approval would ensure that people who need medical treatment can “safely receive care without fear or intimidation.”

Some Republicans pushed back against the package of bills, including outspoken conservative Assemblymember Carl DeMaio (R-San Diego), who said that the raids that Democrats are “making such hay over” were triggered by the state’s “sanctuary” law passed in 2018.

The state law DeMaio attacked, SB 54, bars local law enforcement from helping enforce federal immigration laws, including arresting someone solely for having a deportation order, and from holding someone in jail for extra time so immigration agents can pick them up.

The law, criticized by President Trump and Republicans nationwide, does not prevent police from informing federal agents that someone who is in the country illegally is about to be released from custody.

“If you wanted a more orderly process for the enforcement of federal immigration rules, you’d back down from your utter failure of SB54,” DeMaio said.

Chino Valley Unified School Board President Sonja Shaw, a Trump supporter who is running for state superintendent of public instruction, said that the bills about school safety were “political theater that create fear where none is needed.”

“Schools already require proper judicial orders before allowing immigration enforcement on campus, so these bills don’t change anything,” Shaw said. “They are gaslighting families into believing that schools are unsafe, when in reality the system already protects students.”

But Muratsuchi, who is also running for superintendent, said the goal of the legislation is to ensure that districts everywhere, “including in more conservative areas,” protect their students against immigration enforcement.

A half-dozen other immigration bills are still pending in the Legislature. Lawmakers have until next Friday to send bills to Newsom’s desk before the 2025 session is adjourned.

Those include AB 495 by Assemblymember Celeste Rodriguez (D-San Fernando), which would make it easier for parents to designate caregivers who are not blood relatives — including godparents and teachers — as short-term guardians for their children. An increasing number of immigrant parents have made emergency arrangements in the event they are deported.

The bill would allow nonrelatives to make decisions such as enrolling a child in school and consenting to some medical care.

Conservatives have criticized the bill as an attack on parental rights and have said that the law could be misused by estranged family members or even sexual predators — and that current guidelines for establishing family emergency plans are adequate.

Also still pending is AB 1261, by Assemblymember Mia Bonta (D-Alameda), which would establish a right to legal representation for unaccompanied children in federal immigration court proceedings; and SB 841 by Sen. Susan Rubio (D-Baldwin Park), which would restrict access for immigration authorities at shelters for homeless people and survivors of rape, domestic violence and human trafficking.

Gaza’s health system is in a state of collapse as Israel continues its attacks on medical facilities. A strike on Tuesday hit a UN clinic in Gaza City. The nearby Al Shifa Hospital reported a severe shortage of blood as many people in Gaza are too malnourished to make donations.

June 4 (UPI) — Federal officials have arrested a Washington man they said provided “significant quantities” of explosive materials to the man who attacked a California fertility clinic in a suicide bombing.

The U.S. Attorney’s Office in the Central District of California charged Daniel Jongyon Park of Kent, Wash., with providing and attempting to provide material support to terrorists.

Officials arrested him Tuesday night shortly after he arrived on a flight to John F. Kennedy International Airport in New York City. Park had been deported from Poland where he traveled to in the days after the May 17 attack.

Police said Edward Bartkus of Twentynine Palms, Calif., attacked the American Reproductive Centers location in Palm Springs, Calif., using a vehicle-borne bomb. He was allegedly motivated by his anti-natalist views that people shouldn’t be brought into the world without their consent.

The Justice Department said Park shared Bartkus’ views and bought and shipped more than 200 pounds of ammonium nitrate to Bartkus’ home. Park also joined Bartkus in Twentynine Palms, where the two allegedly conducted experiments on how to build explosives using the chemicals.

Attorney General Pam Bondi thanked the Polish government for assisting in returning Park to the United States to face charges.

“Bringing chaos and violence to a facility that exists to help women and mothers is a particularly cruel, disgusting crime that strikes at the very heart of our shared humanity,” she said.

Four of the six Planned Parenthood clinics in Iowa and four in Minnesota will shut down in a year, the Midwestern affiliate operating them has announced, blaming a freeze in federal funds, budget cuts proposed in Congress and state restrictions on abortion.

The clinics closing in Iowa include the only Planned Parenthood facility in the state that provides abortion procedures, in Ames, home to Iowa State University. Services will be shifted, and the organization will still offer medication abortions in Des Moines and medication and medical abortion services in Iowa City.

Two of the clinics being shut down by Planned Parenthood North Central States are in the Minneapolis area, in Apple Valley and Richfield. The others are in central Minnesota, in Alexandria and Bemidji. Of the four, the Richfield clinic provides abortion procedures.

The Planned Parenthood affiliate said it would lay off 66 employees and ask 37 additional employees to move to different clinics. The organization also said it plans to keep investing in telemedicine services; it sees 20,000 patients virtually each year. The affiliate serves Iowa, Minnesota, Nebraska, North Dakota and South Dakota.

“We have been fighting to hold together an unsustainable infrastructure as the landscape shifts around us and an onslaught of attacks continues,” Ruth Richardson, the affiliate’s president and chief executive, said in a statement Friday.

Of the remaining 15 clinics operated by Planned Parenthood North Central States, six will provide abortion procedures — five of them in Minnesota, including three in the Minneapolis area. The other clinic is in Omaha.

The affiliate said that in April the Trump administration froze $2.8 million in federal funds for Minnesota to provide birth control and other services, such as cervical cancer screenings and testing for sexually transmitted diseases.

While federal funds can’t be used for most abortions, abortion opponents have long argued that Planned Parenthood affiliates should not receive any taxpayer dollars, saying the money still indirectly underwrites abortion services.

Planned Parenthood North Central States also cited proposed cuts in Medicaid, which provides health coverage for low-income Americans, as well as a Trump administration proposal to eliminate funding for teenage pregnancy prevention programs.

In addition, Republican-led Iowa last year banned most abortions after about six weeks of pregnancy, before many women know they are pregnant, causing the number of abortions performed there to drop 60% in the first six months the law was in effect and dramatically increasing the number of patients traveling to Minnesota and Nebraska.

After the closings, Planned Parenthood North Central States will operate 10 brick-and-mortar clinics in Minnesota, two in Iowa, two in Nebraska and one in South Dakota. It operates none in North Dakota, though its Moorhead, Minn., clinic is across the Red River from Fargo, N.D.

Hanna writes for the Associated Press.

Across Los Angeles, the Inland Empire and the Coachella Valley, one community health center is extending its services to immigrant patients in their homes after realizing that people were skipping critical medical appointments because they’ve become too afraid to venture out.

St. John’s Community Health, one of the largest nonprofit community healthcare providers in Los Angeles County that caters to low-income and working-class residents, launched a home visitation program in March after learning that patients were missing routine and urgent care appointments because they feared being taken in by U.S. Immigration and Customs Enforcement agents.

St. John’s, which offers services through a network of clinics and mobile units across the region, estimates that at least 25,000 of its patients are undocumented, and about a third of them suffer from chronic conditions, including diabetes and hypertension, which require routine checkups. But these patients were missing tests to monitor their blood sugar and blood pressure, as well as appointments to pick up prescription refills.

Earlier this year, the health center began surveying patients and found that hundreds were canceling appointments “solely due to fear of being apprehended by ICE.”

President Trump came into his second term promising the largest deportation effort in U.S. history, initially focusing his rhetoric on undocumented immigrants who had committed violent crimes. But shortly after he took office, his administration said they considered anyone in the country without authorization to be a criminal.

In the months since, the new administration has used a variety of tactics to sow fear in immigrant communities. The Department of Homeland Security has launched an ad campaign urging people in the country without authorization to leave or risk being rounded up and deported. Immigration agents are showing up at Home Depots and inside courtrooms, in search of people in the U.S. without authorization. Increasingly, immigrants who are detained are being whisked away and deported to their home countries — or, in some cases, nations where they have no ties — without time for packing or family goodbyes.

The Trump administration in January rescinded a policy that once shielded sensitive locations such as hospitals, churches and schools from immigration-related arrests.

In response to the survey results, St. John’s launched the Health Care Without Fear program in an effort to reach patients who are afraid to leave their homes. Jim Mangia, chief executive and president of St. John’s, said in a statement that healthcare providers should implement policies to ensure all patients, regardless of immigration status, have access to care.

“Healthcare is a human right — we will not allow fear to stand in the way of that,” he said.

Bukola Olusanya, a nurse practitioner and the regional medical director at St. John’s, said one woman reported not having left her home in three months. She said she knows of other patients with chronic conditions who aren’t leaving their house to exercise, which could exacerbate their illness. Even some immigrants in the U.S. legally are expressing reservations, given news stories about the government accusing people of crimes and deporting them without due process.

Olusanya said waiting for people to come back in for medical care on their own felt like too great a risk, given how quickly their conditions could deteriorate. “It could be a complication that’s going to make them get a disability that’s going to last a lifetime, and they become so much more dependent, or they have to use more resources,” she said. “So why not prevent that?”

On a recent Thursday at St. John’s Avalon Clinic in South L.A., Olusanya prepared to head to the home of a patient who lived about 30 minutes away. The Avalon Clinic serves a large population of homeless patients and has a street team that frequently uses a van filled with medical equipment. The van is proving useful for home visits.

Olusanya spent about 30 minutes preparing for the 3 p.m. appointment, assembling equipment to draw blood, collect a urine sample and check the patient’s vitals and glucose levels. She said she has conducted physical exams in bedrooms and living rooms, depending on the patient’s housing situation and privacy.

She recalled a similar drop in patient visits during Trump’s first administration when he also vowed mass deportations. Back then, she said, the staff at St. John’s held drills to prepare for potential federal raids, linking arms in a human chain to block the clinic entrance.

But this time around, she said, the fear is more palpable. “You feel it; it’s very thick,” she said.

While telehealth is an option for some patients, many need in-person care. St. John’s sends a team of three or four staff members to make the house calls, she said, and are generally welcomed with a mix of relief and gratitude that makes it worthwhile.

“They’re very happy like, ‘Oh, my God, St. John’s can do this. I’m so grateful,’ ” she said. “So it means a lot.”

May 18 (UPI) — A 25-year-old man on Sunday has been tentatively identified as the suspect in an explosion outside a Southern California fertility clinic that injured four and and killed one.

The FBI believes Edward Bartkus, a resident of Twentynine Palms, home to a large U.S. Marine Corps base, about 58 miles northwest of Palm Springs, used a vehicle-borne improvised bomb. The explosion occurred at 11 a.m. PDT Saturday and damaged several buildings.

“We are working through some other technical means to positively identify the decedent here, but we believe at this moment, based on the evidence that we’ve gathered, that that is Mr. Bartkus as the decedent here,” Akil Davis, assistant director in charge of the FBI’s Los Angeles Field Office, said at a Sunday morning news conference.

None of those injured are believed to be staff members of the clinic, city officials said.

American Reproductive Centers wrote on Facebook that a “vehicle exploded in the parking lot near our building.”

“Our mission has always been to help build families, and in times like these, we are reminded of just how fragile and precious life is,” the center posted. “In the face of this tragedy, we remain committed to creating hope — because we believe that healing begins with community, compassion, and care,” they wrote in the post.

“Out of every tragedy, there is an opportunity to come together with deeper purpose. While today’s events have shaken us all, they also shine a light on the strength of our community, the bravery of our first responders, and the resilience of the families we serve.

“At ARC, we believe in creating life – not just in the biological sense, but in the emotional and spiritual sense, too,” the post said.

The clinic expects to reopen Monday.

The Center for Reproductive Services and the American Coalition for Telemedicine told CBS News that they had not heard of any threats to their facilities or the organizations they work with across the country.

“We were able to save all of the embryos at this facility,” Davis said. “Good guys, 1, bad guys, 0.”

The blast could be felt more than a mile away from the blast zone and pieces of vehicles were thrown hundreds of feet in the air and then several blocks away.

“You can use your imagination for how big that bomb device was,” Davis said.

People at The Skylark Hotel, about 500 yards from the clinic, said they felt the explosion.

Palm Springs city officials said in a Facebook post that the blast occurred near several healthcare facilities.

“We believe he was the subject found by the vehicle,” Davis said.

The vehicle was a 2010 silver Ford Fusion sedan.

Davis said this is the largest bombing ever investigated in Southern California.

“It does require some planning and some skill to build a bomb of this kind, although we have seen similar devices with even more significant damage before including the horror of the Oklahoma City bombing in 1995 and the blast that rocked the World Trade Center during the first attack in February 1993,” Law Enforcement analyst Richard Esposito told CBS News.

Barkus has not been in the FBI’s radar, according to Davis.

In writing or recordings, the suspect was against bringing people into the world against their will, according to CBS law enforcement sources familiar with the investigation.

“The subject had nihilistic ideations and this was a targeted attack,” Davis said. “We believe he was attempting to livestream it and yes, that is also part of our investigation.”

On Saturday, Davis said: “Make no mistake, this is an intentional act of terrorism.”

The Bureau of Alcohol, Tobacco, Firearms and Explosives also sent agents to help with the investigation.

“Yesterday, a man intent on harming others in our city failed. Palm Springs survived and we are stronger and more resilient as a result,” Palm Springs Police Chief Andrew Mills said during Sunday’s news conference. “Our determination to continue life as we know it here in Palm Springs continues unabated and you’ll see this city dynamically grow as a result of this.

Late Saturday, the FBI and the San Bernardino Sheriff’s Office evacuated residents in the Twentynine Palms neighborhood where the suspect lived and more than 50 miles from the blast.

“I can confirm that we were executing a search warrant at that location in Twentynine Palms as a result of this explosion here,” Davis said. “Some residents were evacuated in the neighboring area as a practice of protocol and safety. We do not believe that there is an ongoing threat to the public in the Twentynine Palms area as a result of this investigation.”

Video shows aftermath of an explosion outside a fertility clinic in Palm Springs, California that killed one person. The FBI says the blast, which damaged several buildings, was an ‘intentional act of terrorism’.

Palm Springs Police Chief Andy Mills said the blast ‘appears to be an intentional act of violence’.

At least one person has been killed after an explosion near a reproductive health facility in Palm Springs, California, the city’s mayor said.

Palm Springs Police Chief Andy Mills said the blast on Friday “appears to be an intentional act of violence” and that several buildings were damaged, some severely.

“There has been one fatality, the person’s identity is not known,” Mills’ statement said.

The city’s mayor, Ron deHarte, said a bomb was either in or near a car parked outside of the clinic when it exploded, the Reuters news agency reported.

Palm Springs Fire Chief Paul Alvarado said no suspect had been identified.

Authorities said the blast occurred on Saturday around 11am local time (18:00 GMT) near North Indian Canyon Drive and East Tachevah Drive. Police urged residents to avoid the area as fire crews and investigators secured the scene.

Federal agents from the FBI and the Bureau of Alcohol, Tobacco, Firearms and Explosives were dispatched to support the local investigation, which remains in its early stages.

The blast damaged the American Reproductive Centers facility, a fertility clinic run by Dr Maher Abdallah. He told The Associated Press that, while his office space suffered damage, the in-vitro fertilisation (IVF) lab and its stored embryos were untouched.

“I really have no clue what happened,” Abdallah said. “Thank God today happened to be a day that we have no patients.”

He added that all his staff were safe and accounted for.

Nearby resident Nima Tabrizi, 37, from Santa Monica, said he was inside a cannabis dispensary when he felt the building shake.

“The building just shook, and we go outside and there’s a massive cloud smoke,” Tabrizi said. “Crazy explosion. It felt like a bomb went off … We went up to the scene, and we saw human remains.”

Palm Springs, a wealthy desert city known for its luxury resorts and celebrity history, is located about 100 miles (161km) east of Los Angeles.