A doctor wanted to protect him from law enforcement. So she made up a diagnosis.

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A 29-year-old Venezuelan man was brought into a Chicago emergency room by Immigration and Customs Enforcement agents. Four agents stood outside the exam room, their weapons visible. The man had a deep gash above his eyebrow, bruised ribs, and a head injury. He needed stitches and imaging.

Dr. N and the patient both understood what might happen next. Discharge could mean transfer to the Broadview Detention Center, a facility widely feared in immigrant communities and known to physicians and attorneys for documented allegations of abuse and inhumane conditions. (Dr. N shared her story on the condition that her full name not be used due to fear of repercussions from her employer.)

Seeing the agents, Dr. N felt the tension. Her parents had immigrated to the United States from Iran, and during Operation Midway Blitz agents had once stopped her, she believes, for appearing Hispanic. But when she entered the exam room, her own unease receded as the patient’s anxiety filled the space. With the help of an interpreter, she examined his injuries and made a deliberate decision.

She admitted him to the hospital.

The diagnosis Dr. N entered—possible pneumonia—provided justification, but it was not the reason she admitted him. She felt responsible for the patient’s future, so she made up a diagnosis to orchestrate an admission. Dr. N figured that immigration agents could not simply wait in the hallway. She hoped they would leave.

They did.

That moment reveals a truth physicians understand instinctively: When immigration enforcement enters hospitals, doctors are forced to choose between compliance and the integrity of medical care itself.

What happened in that Chicago emergency room is no longer an exception. In Minneapolis, physicians warned at a recent press conference that immigration enforcement had crossed a dangerous line—into the exam room itself. Patients are skipping appointments, electing for home births, and avoiding hospitals altogether out of fear of encountering ICE. Several physicians said the disruption feels worse than the height of COVID, with widespread fear, chaos, no clear end in sight.

It also illuminates what is at stake as Ohio lawmakers consider House Bill 281, legislation that would require hospitals across the state to permit ICE agents to operate inside medical facilities. Hospitals that refuse—many already operating on thin margins—could face severe penalties, including the loss of Medicaid provider agreements and state grant funding. If Ohio succeeds, other states will likely follow, establishing a precedent that reshapes the risks patients face when they walk through hospital doors.

Hospitals are not courts, and physicians are not arbiters of guilt. This bill does not merely alter hospital policy; it fractures the foundation of the doctor–patient relationship. When ICE enters the exam room, medical judgment is compromised, regardless of why a patient is detained.

In health care, we ask questions that require extraordinary vulnerability: Have you thought about harming yourself? Are you sexually active? Do you feel safe at home? These questions are essential to prevention, diagnosis, and treatment. No patient can answer them honestly if a hospital feels like a place of surveillance. Even U.S. citizens hesitate when what should be a refuge begins to resemble law enforcement. Handguns. Handcuffs. Face coverings. Tactical gear. Ballistic vests.

I served as chief resident and board member at a clinic that served uninsured immigrant patients. We never asked about citizenship status—not because it was irrelevant, but because we understood the cost of the question itself. Treating a patient requires understanding them as a whole person, their culture, life experiences, prior trauma. But many patients feared that if they were honest, medical providers would report them to immigration authorities. When patients believe that honesty could place them at risk, they withhold information. Without candor during a history and physical, medicine fails.

The consequences are not abstract. Among immigrant patients with chronic illnesses such as diabetes, barriers to consistent care are associated with poorer outcomes and higher rates of serious complications. When patients delay routine treatment out of distrust or lack of insurance, diabetes does not remain stable. It progresses to dialysis, ICU admissions, and expensive, lifelong care.

If hospitals become sites of immigration enforcement, this chain reaction will only accelerate. Physicians see this pattern repeatedly. Not in theory, but at the bedside.

The damage extends beyond patients to physicians themselves. Doctors are bound by the Hippocratic oath to place patient welfare first, protect confidentiality, and avoid harm. When clinicians are forced to invent work-arounds—stretching diagnoses or manipulating admissions simply to shield patients—they experience moral injury.

Physicians have long practiced on a narrow bridge between politics and patient care, though few expected the work itself to feel political. We treat gunshot wounds not because we want to engage in gun-policy debates but because political decisions shape who is injured and how often. We counsel pregnant patients through complex decisions while navigating restrictive abortion laws.

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Some states have taken a different path—one Ohio lawmakers can still adopt. In December, Illinois Gov. J.B. Pritzker signed House Bill 1312 into law, extending protections for immigrants in hospitals, schools, and courthouses. The law requires hospitals to establish clear procedures governing interactions with law enforcement, protect patient information, and designate legal contacts when enforcement actions occur. Its purpose is straightforward: Seeking medical care should not place patients at risk of detention or deportation.

Illinois’ choice was not symbolic. It was pragmatic medicine, grounded in the understanding that health care works only when patients can speak freely.

Patients have always lived in a health care system where outcomes depend in part on where they seek treatment. Whether someone survives a heart attack may hinge on the hospital they enter. What is different now is that government policy is actively accelerating those disparities. States are increasingly determining not only which procedures are legal or accessible but whether immigrants can seek hospital care without fear of detention.

History will not remember the bill numbers or the floor debates. It will remember whether states chose to keep hospitals as places where illness could be diagnosed and treated without suspicion or consequence. A health care system that cannot hear its patients cannot heal them.

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