In summary
Fear of immigration raids is driving Southern California patients to cancel health care. A third of medical appointments and half of dental appointments at St. John’s 28 clinics were cancelled this week.
California hospitals and clinics are on high alert as immigration raids continue and their patients — both legal residents and undocumented immigrants — afraid to step out are increasingly canceling medical appointments.
One Los Angeles-area clinic system, St. John’s Community Health, told CalMatters about a close encounter with officials who appeared to be immigration agents. Staff said armed officers wearing tactical gear tried to enter a parking lot in Downey, about 10 miles southeast of Los Angeles, where doctors and nurses in a mobile health clinic were seeing patients, many of them walk-ins from the community.
Alfredo Contreras, the driver of the mobile clinic, said five unmarked SUVs and vans on Wednesday evening pulled up to a gate in the parking lot where they had set up, located at a drug and alcohol recovery center. Contreras and a security guard stood in front of their vehicles, blocking the entrance.
Contreras said he and the guard “held our ground, we did not move” and the officers didn’t get out of their vehicles.
“I told (the security guard) ‘Don’t worry, they can’t come in without a warrant,’ so I’m sure they (agents) could hear us because their windows were down,” Contreras said.
Both of them started walking back as the center’s gate slowly closed in front of them. The agents eventually left after a few minutes, Contreras said.
Peggy Hernandez, the mobile clinic coordinator who also was at the scene, said while Contreras and the security guard dealt with the agents, her staff calmly alerted patients who were waiting in line. None identified themselves as being at risk because of their legal status, but still, she said both patients and staff were shaken up.
“That’s the first time they (immigration officials) have ever come that close to the clinic or to us providing health care services,” said Jim Mangia, CEO of St. John’s Community Health. Staff at the clinics, he said, have been training for this type of situation.
Growing fear and cancelled health appointments
One of President Donald Trump’s first orders upon taking office in January was to rescind a Biden-era rule that protected “sensitive locations” — places of worship, hospitals, clinics and schools — from immigration operations.
In an email response to CalMatters, Tricia McLaughlin, assistant secretary for public affairs at the Department of Homeland Security, did not address whether U.S. Immigration and Customs Enforcement agents visited any LA-area medical clinics this week.
But asked why ICE would target such locations, McLaughlin said the administration is protecting “Americans who attend” these sensitive locations “by preventing criminal aliens and gang members from exploiting these locations and taking safe haven there because these criminals knew law enforcement couldn’t go inside under the previous administration.”
“ICE will be using the ‘common sense’ standard for any enforcement actions at these locations, relying on the discretion of the law enforcement officer.”
TRICIA MCLAUGHLIN, DEPT. OF HOMELAND SECURITY“Officers would need secondary supervisor approval before any action can be taken in locations such as a church or a school. We expect these to be extremely rare,” McLaughlin said in the email.
Trump’s directive “gives our law enforcement the ability to do their jobs…ICE will be using the ‘common sense’ standard for any enforcement actions at these locations, relying on the discretion of the law enforcement officer,” she said.
Government data and news reports show that ICE is increasingly detaining people without criminal convictions. The same day that immigration agents tried to enter the Downey parking lot where St. John’s mobile health van was stationed, some also showed up outside two nearby churches where they apprehended people, including one elderly man, according to local news reports.
Health advocates and providers say that rather than protecting people, ICE is scaring people from seeking basic medical care.
That fear is expected to grow, especially after, as the Associated Press first reported Friday, the Centers for Medicare and Medicaid Services shared Medi-Cal data, including people’s immigration status, with the Department of Homeland Security. California officials, including the state’s Department of Health Care Services which oversees Medi-Cal, have long reassured undocumented immigrants that their personal information would not be shared with federal agencies for immigration enforcement.
At St. John’s, which has 28 sites across Los Angeles County and the Inland Empire, Mangia estimates that roughly a third of medical appointments and half of dental appointments were cancelled this week.
People have been skipping care out of fear for months now, but recent raids have increased the no-shows and cancellations. When possible, his clinics are turning people to telehealth and a recently-launched home visitation program, he said.
The Hospital Association of Southern California said on Thursday that it was not aware of any immigration enforcement activity inside or directly outside any Southern California hospital campus, but that the chilling effect was noticeable in some emergency waiting rooms.
“Some hospitals have reported a decline in emergency department volume, which raises our concern that individuals may be delaying necessary care out of fear,” Adam Blackstone, a spokesperson for the association, said in a written response.
“Fear of going outside or being picked up by ICE…can create worse outcomes, such as ending up on my operating room table with an amputation or a ruptured appendix.”
SANDY REDING, CALIFORNIA NURSES ASSOCIATIONSandy Reding, an operating room nurse at Bakersfield Memorial Hospital and president of the California Nurses Association, said anecdotes of similar patterns were reported in Bakersfield following January raids there.
The consequences of putting off care are never good, especially for people with chronic conditions, such as diabetes and hypertension, she said.
“Not having the optimal care because of fear of going outside or being picked up by ICE creates delays in care, which can create worse outcomes, such as ending up on my operating room table with an amputation or a ruptured appendix,” Reding said.
“My concern right now is that we take care of everybody in a timely manner, and that they feel that the hospital is a safe place to go to get care,” she said.
Many patients seeking virtual care
For non-emergency care, patients have more options. The Los Angeles County Department of Health Services has published resources for remote care. Included are phone numbers and portals where county clinic patients can call a nurse advice line and request medication drop-offs. The department encourages people who would rather stay home to call their clinic and change their appointments to virtual or phone visits.
Officials with the county health department said immigration agents have not entered any of their county health facilities. “However, the mere threat of immigration enforcement near any medical facility undermines public trust and jeopardizes community health,” they wrote in an unsigned email.
People without a preferred clinic may also seek services from organizations such as Zócalo Health, which provides virtual-first care, including mental health visits. The group was created to boost culturally competent care in Latino communities, said CEO Erik Cardenas. Services are available for people throughout California, including those covered by certain Medi-Cal plans. People can call the group’s main line to check insurance eligibility and book appointments online.
“Having a virtual network of physicians and therapists that look like you, talk like you, think like you, is a really good tool to have right now because it augments access,” Cardenas said.
Since the pandemic, most clinics and doctors’ offices across the state now offer virtual care.
‘A devastating contradiction’
The immigration raids are coinciding with major proposed rollbacks in Medi-Cal for undocumented people.
As the state tries to offset a projected $12 billion deficit, Gov. Gavin Newsom last month put out a budget proposal that freezes enrollment and reduces services for this population. State health officials have said the state is spending more on medical coverage and prescription drugs for undocumented enrollees than they anticipated.
The Legislature, in its own version of the budget, on Friday accepted most of Newsom’s freezes and cuts for immigrants with some modifications. For example, lawmakers want to charge undocumented immigrants $30 a month for their Medi-Cal insurance instead of the $100 that Newsom proposed. Legislators also want a six-month grace period for people to re-enroll if they fall off coverage for missing payments.
Lawmakers and Newsom face a June 27 deadline for agreeing on a final budget.
Republican lawmakers say the governor and Democratic lawmakers are responsible for a Medi-Cal expansion that has become unsustainable. “We committed spending to something we can’t afford,” Sen. Roger Niello, a Republican from Roseville and vice chair of the Senate budget committee, has told CalMatters.
The exam room where patients see health providers inside a mobile clinic operated by St. John’s Community Health. Photo by Jules Hotz for CalMattersMeanwhile, health and immigration advocates are pushing the state to keep immigrants covered, especially in this time of fear.
Mar Velez, director of policy at the Latino Coalition for a Healthy California, said it doesn’t make sense for Democrats to defend immigrants in the face of the federal immigration raids and at the same time go after their health coverage.
“They’ve been very clear that we need to protect immigrant communities, and so why isn’t the state budget reflecting that?” she said.
Mangia at St. John’s said his clinics’ staff have been getting questions from patients almost daily about the future of their Medi-Cal coverage.
“Our patients are very worried about it,” he said. “And I think it’s a devastating contradiction, on the one hand to have the governor and elected officials say we support immigrants, but when it comes to making sure that they have health care, they’re willing to kind of cut those services away.”
Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.
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