What to do if ICE shows up at your medical practice

Katie P. Russell

Hospitals and medical practices are facing new uncertainty as federal immigration enforcement returns to the nation’s health care settings. Earlier this year, the Department of Homeland Security rescinded a Biden-era policy that had treated hospitals, schools, and churches as “sensitive locations” largely off-limits to Immigration and Customs Enforcement (ICE). That change, reported by Axios, has already prompted confusion and fear across the health care system — and left physicians wondering what to do if agents arrive at their door.

“It’s usually unannounced,” said Katie P. Russell, partner at Brown Immigration Law in Cleveland, Ohio. “You want to make sure you’re prepared so that element of surprise doesn’t throw you or your staff off.”

Russell said preparation is the single most effective way to keep staff calm and the practice protected.

Designate a point of contact and a plan

Russell recommends that every practice designate a single staff member, ideally an administrator or HR representative, as the official point of contact for any law-enforcement interaction — including ICE. “That person should be trained to review any paperwork, communicate respectfully with agents, document what happens, and call counsel immediately,” she said.

She added that smaller offices should name a backup contact as well, in case the lead administrator is away. “Having a plan makes you look organized and helps ensure you don’t say or do something that could harm the practice,” Russell said.

If a receptionist or nurse is approached first, Russell said the right move is to politely defer: “It’s perfectly fine to say, ‘I’m not authorized to speak with law enforcement. Please give me a few minutes while I contact our compliance officer or attorney.’”

Understand what kind of warrant you’re seeing

One of the biggest points of confusion is the difference between administrative and judicial warrants.

“An administrative warrant — the kind ICE usually carries — does not authorize entry into private areas,” Russell said. “Those documents might look official, with DHS or ICE logos and form numbers starting with an ‘I,’ but they don’t have the power of a judge’s signature.”

By contrast, a judicial warrant carries the authority of the court. “It will have a judge’s signature and a court heading, and it’s specific about what agents are allowed to do,” she said. “If you don’t see that, you are not required to grant them access beyond public areas.”

Russell said her firm frequently conducts training sessions to help practices recognize these differences. “We show staff what these documents look like so they aren’t making snap decisions when someone in a badge is standing in front of them.”

HIPAA protections still apply

Even though hospitals and clinics no longer enjoy “sensitive location” status, HIPAA privacy rules remain fully in effect.

“HIPAA protects all patient health information, regardless of immigration status,” Russell said. “Agents can’t access treatment rooms or patient charts without either a judicial warrant, explicit patient consent — which we don’t recommend — or a court order that clearly authorizes what they’re allowed to see.”

In its report, Axios described how the end of the policy has already unnerved clinicians: some emergency-department workers said they’ve begun hiding whiteboards with patient names and limiting who can access secure areas when agents are nearby. Health care attorney Douglas Grimm told Axios: “The judicial warrant needs to be specific as to the place and who you’re looking for. It’s not going to say you can just walk into the ICU and check everybody.”

Russell agreed. “The law hasn’t changed when it comes to patient privacy,” she said. “Only the enforcement environment has — and that makes it even more important that practices know the limits.”

If ICE asks about an employee or doctor

When immigration officers come looking for a staff member or physician, Russell said practices must walk a “very careful line.”

“Once someone is hired, the employer’s legal obligation is to complete and maintain Form I-9 verifying that person’s authorization to work in the United States,” she said. “But you are not required to hand over information or personnel files without a valid legal request.”

Over-cooperating, she warned, can be as damaging as refusing to comply. “Volunteering information can violate privacy laws and employee rights,” she said. “Your safest response is to contact your attorney immediately and let them handle communications.”

Russell also recommends regular internal I-9 audits to catch missing signatures or expired documents. “It’s one of the simplest ways to prevent a small paperwork issue from becoming a big enforcement problem,” she said.

When and how to involve counsel

Practices should connect with immigration counsel before any visit occurs, Russell said. “We meet with the practice leader, check that all the I-9s are organized, and make sure everyone understands which parts of the office are public and which are private.”

She said she’s responded to calls in real time when ICE arrives. “I’ve driven straight to offices where agents are on-site. The first thing I do is ask to see their documentation. Just hearing that an attorney is coming usually changes the tone of the encounter.”

After ICE leaves

“The visit might last 10 minutes or an hour, but the follow-up lasts much longer,” Russell said. “You want to document everything: who came, what they said, what paperwork they showed, and what time they arrived and left.”

That record helps counsel verify whether agents exceeded their authority and guides any needed follow-up with federal officials. “It’s your insurance policy against misunderstanding,” she said.

For practices employing international physicians

Many medical offices rely on international medical graduates or visa-sponsored doctors, making immigration compliance part of everyday operations. “If you’ve got talented people on work visas, make sure you know their status, renewal dates and long-term options,” Russell said. “We help practices set up calendars and audits so nothing slips through the cracks.”

She added that some employers can even pursue permanent residency for those physicians. “If they’re doing good work and you want to keep them, talk to your immigration counsel about sponsorship,” she said.

A changed enforcement landscape

According to Axios, the rollback of the sensitive-location policy has already produced “a chilling effect” in emergency departments, where doctors fear that patients may delay or avoid care. Clinics serving immigrant communities are likewise reviewing access policies and updating staff training.

Russell said the renewed enforcement underscores the need for preparation rather than panic. “Just being prepared — knowing what you can and cannot do — takes a lot of the heat off a visit like that,” she said. “Even if you never have to use the plan, it’s worth having. It’s peace of mind.”