More than 40 doctors representing Minnesota’s major health systems and organizations came together this week to share how the intense U.S. Immigration and Customs Enforcement presence in the state is harming patients.
As stories of ICE agents impeding health care proliferate, fear has taken priority over health concerns, the doctors said. Patients are skipping appointments in “alarming” numbers and leaving prescriptions on pharmacy shelves, they said.
“People are scared to even pick up the phone,” said state Sen. Alice Mann, DFL-Edina, who is also a physician, at Tuesday’s news conference at the Minnesota State Capitol. “People are deprioritizing health.”
Dr. Janna Gewirtz O’Brien, assistant professor of pediatrics at the University of Minnesota Medical School, said fear creates dilemmas every day in clinical practice.
“As a simple example, when I was working in the newborn nursery at a hospital, trying to send babies home from the hospital — a day that should be the best day for a family — one of the babies needed to come back for a hospital visit for the next day,” she said. “The baby was ready to go and healthy, but the family looked out the window and said, ‘ICE is outside. If we go, we are absolutely not coming back.’ People are afraid to come in, they’re afraid to leave, and staff are worried about being detained — even when they have legal status.”
The doctors said they’re doing everything they can to provide safe access. Many are calling to check on patients who don’t show up to appointments. But they said that with ICE agents disregarding laws, some things are out of their control.
“Even if we say we protect your information, we may not have the power to do that under the current administration,” said Dr. Nathan Chomilo, a HealthPartners pediatrician at Park Nicollet Clinic Brooklyn Center Brookdale.
What should you do if you’re afraid that seeking health care could put you in danger? We talked to doctors, a pharmacist and other health experts to find out.
Routine/nonurgent care
“We are seeing more patients request virtual options,” said Maria Medina, director of equity initiatives at M Health Fairview.
Hospital systems, including M Health Fairview, are expanding those options to encourage people to stay connected to health care, she said.
Some doctors and systems are reaching out to patients to offer these options. But you can also ask your provider what aspects of care can be managed online, doctors said. Even if you have an in-person appointment scheduled, you can call and request a switch to telehealth.
Options usually include phone and video appointments. Some systems offer additional online resources: At M Health Fairview, “E-visits are available 24/7 for dozens of minor conditions and don’t require an appointment or a trip to the clinic,” Medina said. Patients answer questions through an online platform, and a provider follows up with a plan or recommendation.
You can also access telehealth through the state’s Medicaid program, which is available without co-pays, Chomilo said.
Medication
There are a variety of ways to get medication without leaving your home or car, said doctors and pharmacists who serve vulnerable patients at community clinics — and the list is expanding. Their advice:
- Streamline refills: Change 30-day prescriptions to 90 days to minimize the number of times you need to pick up medications. If your prescription has refills, a pharmacist can probably make this change. Otherwise, ask your provider to change the prescription to the maximum amount. Many pharmacies also have “medication synchronization programs,” allowing you to pick up all your prescriptions at the same time.
- Switch to mail order or delivery: Many pharmacies, from big chains to small-town independent stores, offer delivery or mail options. Fees vary, but some are free.
- Switch pharmacies: If your pharmacy doesn’t offer the above services, switch to one that does. Call your insurance provider first, as co-pays may vary from pharmacy to pharmacy.
- Call first to process your refill: Many patients show up in person to ask for refills, but that can almost always be done over the phone. That will shorten time spent inside a store.
- Ask a friend for help: In most cases, anyone who knows your name and birth date can pick up your prescriptions. (M Health Fairview offers more details.)
- If you do pick up medication in person, many pharmacies offer curbside or drive-through service.
- Stay tuned: Doctors said they are organizing additional services to ensure safe access to medications, in addition to other care. “Some of it is building on infrastructures we’ve had in place since Covid, and some is expanding,” Gewirtz O’Brien said. Health systems are afraid to advertise it because of retaliation, so she advises calling your health care offices for more information.
Finally, some providers recommend that their patients carry a list of their prescriptions with them. Your clinic can provide a complete list.
Mental health
“It’s important for everyone to take care of themselves — mentally, emotionally, and physically, especially during stressful times,” Medina said. “For me personally, that means taking breaks from the news and social media, connecting with loved ones and community, and getting rest.”
Trauma can lead to long-term physical health issues, Chomilo said, and trauma doesn’t even need to be experienced first-hand.
“That is a real concern, that what children are seeing and witnessing in schools, day care centers, with their families, can cause vicarious trauma,” he said.
Parents can help mitigate the effects of such experiences by talking to their children. He offers his patients’ families these guidelines from the University of Colorado to guide the conversation.
Children pick up on the nonverbal energy of adults, he said, adding, “So as we are carrying this heaviness as parents, children will feel that.” It’s important to learn how to talk about it and check in with children to decrease some of that stress, he said.
You can also find additional resources open to the public, such as psychological first-aid trainings that “focus on supporting community resilience and helping people navigate stress and uncertainty,” Medina said.
These events, which “share practical tools for coping and connections,” are free and open to the public. Find dates and registration info here.
Urgent/emergency care
Although patient privacy laws should protect you inside patient rooms in clinics and emergency rooms, ICE has been violating these laws, medical providers say.
If you’re not sure of your hospital’s policies, look for signs signaling safety on the system’s website or waiting room, Chomilo suggested.
“At Park Nicollet, we reiterate that commitment to safety and privacy and that everyone is welcome, included and valued — and we don’t ask about immigration status,” he said.
Most health care providers in the Twin Cities take similar stances, he said, adding, “We’re here to care for patients according to their needs. If you aren’t seeing signs of that at your provider — if it’s not clear from [a] website or waiting room — I would be cautious. But if you are seeing those things quite clearly, that should be reassuring.”
Still, it’s hard to provide complete reassurance, Gewirtz O’Brien said.
“I wish all hospitals could be considered fully private, but some hospitals have certain areas that are public and certain that are private,” Gewirtz O’Brien said. “Hospitals are trying their best to keep everyone safe. But even the hospitals that are not allowing ICE are still surrounded by ICE agents.”
You may also be able to minimize the amount of time spent in waiting rooms. Some systems, including Park Nicollet, allow you to check in for urgent care online and wait for your appointment at home, for example. You can also often check on wait times before going in, and avoid the busiest times.
When you arrive at urgent care or an emergency room, you may ask at the front desk to be sent to a patient room immediately, although that request can’t always be accommodated, Chomilo said.
You could also bring a friend or volunteer from a mutual aid organization, Gewirtz O’Brien said.
Most important: Be sure to weigh the risks of the possibility of engaging with ICE against the risks to your health, he advised.
If you’re experiencing a true medical emergency, don’t wait, Chomilo said. “If you’re concerned about breathing, weakness, dehydration, passing out, chest pain, the worst headache of your life — you shouldn’t wait. Those things can take you from the community much quicker than even ICE.”
Please call, Gewirtz O’Brien said. “If someone says you need to come in, we will do every single thing to protect you,” she said. “But call first and come in only if you need to. We will figure out a way to get you there safely.”
Long-term impacts on care and trust
During the COVID-19 years, delaying care proved detrimental to health outcomes in a number of ways. Doctors fear the current disruption could cause similar negative impacts.
“The reason health care has a place in our society of high esteem is because folks trust that when they go to the doctor or get cared for by a nurse or therapist, their best interests in terms of privacy, confidentiality and a focus on their health are there,” Chomilo said. “The erosion of that trust accelerated during COVID, and this further erodes that trust.
“Trust takes time to rebuild,” he said. “We’ve already been working to repair trust from marginalized communities. We’ve been making small steps and progress, and this just puts all that on pause and sets it back.”
