clinics

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federal restrictions on immigration enforcement in or near sensitive areas, including health care establishments, were rescinded by the Trump administration in January.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.

July 9 (UPI) — The Justice Department on Wednesday announced that it had sent more than 20 subpoenas to doctors and clinics performing gender-affirming care for minors, as the Trump administration ramps up its attacks on this marginalized community.

No information about the doctors and clinics subpoenaed was provided by the Justice Department, though it suggested the subpoenas were part of investigations into “healthcare fraud, false statements and more.”

“Medical professionals and organizations that mutilate children in the service of a warped ideology will be held accountable by this Department of Justice,” Attorney General Pam Bondi said in a statement.

On June 18, the Supreme Court upheld a Tennessee law restricting access to gender-affirming care for minors.

The subpoenas come despite every major American medical association supporting gender-affirming care for both adults and youth, including the American Academy of Pediatrics.

Gender-affirming care includes a range of therapies, from psychological, behavioral and medical interventions, with surgeries for minors being exceedingly rare. According to a recent Harvard study, cisgender minors and adults were far more likely to undergo analogous gender-affirming surgeries than their transgender counterparts.

Despite the support of the medical community and the evidence, conservatives, Republicans and the Trump administration have continued to target this community with legislation affecting their medical care and rights.

The subpoenas were announced the same day that the Federal Trade Commission hosted a day-long workshop titled “The Dangers of Gender-Affirming Care for Minors,” during which Melissa Holyoak, an FTC commissioner, said that while they cannot make policy decisions limiting gender-affirming care, they can target the medical practice for deceptive statements.

“The FTC has previously enforced — and will continue to enforce — against deceptive representations made by medical practitioners, including claims in connection with treatments for transgender children,” she said, according to a copy of her remarks.

Also on Wednesday, the Department of Justice sued California over alleged Title IX violations concerning transgender athletes competing in women’s and girls’ sports.

The Democratic-led state has refused to comply with the Trump administration’s ban on transgender women and girls competing in sports that align with their gender identity.

Since returning to the White House in January, President Donald Trump has signed several executive orders targeting transgender Americans, including one directing the federal government to recognize only two sexes determined at “conception,” another restricting gender-affirming care for youth and a third banning transgender Americans from the military.

WASHINGTON — The Supreme Court ruled Thursday that states may exclude Planned Parenthood clinics from providing medical screenings and other healthcare for women on Medicaid.

The court’s conservative majority reversed the longstanding rule that said Medicaid patients may obtain medical care from any qualified provider.

In a 6-3 vote, the justices ruled the Medicaid Act does not give patients an “individual right” to the provider of their choice.

The dispute has turned on abortion. Medicaid is funded by the federal government and the states. For decades, conservative states have argued their funds should not be used in Planned Parenthood clinics because some of those clinics perform abortions.

But until now, the federal government and the courts had said that Medicaid patients can go to any qualified provider for healthcare.

In dissent, Justice Ketanji Brown Jackson said the decision “will deprive Medicaid recipients in South Carolina of their only meaningful way of enforcing a right that Congress has expressly granted to them. And, more concretely, it will strip those South Carolinians — and countless other Medicaid recipients around the country — of a deeply personal freedom: the ability to decide who treats us at our most vulnerable.” Justices Sonia Sotomayor and Elena Kagan agreed.

Planned Parenthood clinics provide cancer screenings, birth control medical screenings, pregnancy testing, contraception and other healthcare services.

Congress pays most of the state’s costs for Medicaid, and it says “any individual eligible for medical assistance” may receive care from any provider who is “qualified to perform the service.”

Lupe Rodríguez, executive director of National Latina Institute for Reproductive Justice, called the decision “an attack on our healthcare and our freedom to make our own decisions about our bodies and lives. By allowing states to block Medicaid patients from getting care at Planned Parenthood health centers, the Court has chosen politics over people and cruelty over compassion.”

Three years ago, the Supreme Court overturned Roe vs. Wade and ruled states may prohibit nearly all abortions.

Nonetheless, South Carolina continued its legal fight to prevent Medicaid patients from receiving care at Planned Parenthood’s clinics in Charleston and Columbia.

Former Gov. Henry McMaster, who issued the ban on Planned Parenthood in 2018, said he did so to protect “his state’s sovereign interests.”

Critics of the move said the state has a severe shortage of doctors and medical personnel who treat low-income patients on Medicaid.

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.”