At Zuckerberg San Francisco General’s emergency department, clinicians say a new routine has set in: immigration officers arrive with detained patients at triage, linger at bedsides and, in some cases, detain people on hospital grounds. Staff say it interrupts care and erodes trust between patients and medical teams. The strain falls hardest on safety-net hospitals already running close to capacity and forces clinicians to juggle patient privacy, professional ethics and federal mandates right at the bedside.
Policy change opened hospitals to enforcement
Staff trace the shift to a Department of Homeland Security directive issued in January 2025 that revoked long-standing “sensitive locations” protections and opened the door to arrests at schools, places of worship and medical facilities, as reported by AP. Advocates and some health systems warned the move would discourage people from seeking care and put clinicians directly in the middle of immigration enforcement operations.
Rising deaths and overcrowded ERs
The human toll has been severe: 32 people died in ICE custody in 2025, the highest count in decades, and many of those deaths occurred after detainees reached hospitals, according to the San Francisco Chronicle. Emergency departments report more patients arriving sicker, later and under the watch of enforcement officers, which complicates triage, consent and discharge decisions.
Payments halted, care denied
On top of that, ICE stopped processing third-party medical claims on Oct. 3, 2025, leaving outside providers unpaid and, in some cases, unwilling to offer services, an investigation by Popular Information found. Government notices and contract records show the VA Financial Services Center ended its role handling those claims and ICE brought in private vendors to take over, a gap that advocates say has left detainees without continuity of care.
Oversight investigations have also documented serious problems inside detention facilities. A Senate inquiry led by Sen. Jon Ossoff identified dozens of credible reports of medical neglect and of people being denied food or water, findings his office published last fall. Those patterns help explain why hospitals are now treating more patients whose chronic or acute conditions worsened while they were in detention.
California law tries to push back
California has tried to draw a brighter line around hospital doors. State lawmakers passed Senate Bill 81, and officials issued guidance that aims to protect patient privacy and limit immigration enforcement access to nonpublic care areas. The California Attorney General’s office summarized the rules in a bulletin that treats immigration status and place of birth as protected medical information and urges facilities to adopt strict protocols for handling enforcement requests, according to the California Department of Justice.
Clinicians say the ethical burden is real
“The moral injury inflicted on clinicians to abandon their oath and ethical duty to patients is immense,” Dr. Theresa Cheng, an emergency physician at UCSF-ZSFG, wrote in an opinion piece describing the day-to-day strain. Hospitals are responding with concrete steps such as revising visitor and visitor-access policies, carving out nonpublic care zones and retraining staff on documentation and release procedures. Some payers and provider organizations have circulated guidance to help with compliance, including materials from Health Net…