A U.S. Department of Homeland Security and Immigration and Customs Enforcement program that aims to build partnerships with local organizations such as hospitals and medical clinics has set off alarms in communities on high alert in the wake of President Trump's immigration crackdown.
The Critical Infrastructure Outreach Program was launched in Orange County last November with the stated purpose of helping DHS investigators identify criminal activity and "develop potential sources of information."
But when ICE officials visited Mission Hospital in Mission Viejo in February to promote the program, they were turned away, leaving hospital administrators and immigration advocates concerned about the approach.
"ICE officials were asked to leave immediately because it was determined that there was no need for them to be here from a medical care perspective and a hospital is a place for medical care and anybody in the community is free to use that," said Deb Franko, the hospital's executive director of communications.
According to ICE policy, hospitals are considered "sensitive locations" along with schools, places of worship and political demonstrations. The locations are typically off-limits for ICE searches, interviews, arrests and surveillance unless a supervisor has approved the action and other strict conditions have been met.
The visit to Mission Hospital did not involve an enforcement action, but it was nonetheless concerning for the hospital, Franko said.
"We do not want any impression that there's any activity going on on campus that takes away from our goal of medical care in a safe environment for the community," she said. "So we always want the hospital to be a place where all are welcome who have a medical need to seek care on our campus without any fear or hesitation."
Franko also said patients have privacy rights and "rights for their personal origin not to be disclosed."
Information about patients is protected under the Health Insurance Portability and Accountability Act of 1996 or HIPAA. The federal medical privacy law prohibits disclosure of medical records unless, for example, there is a court subpoena. In such cases, a patient has the right to object to the release of their information.
If ICE were to seek information on whether patients were living in the U.S. illegally, it's unlikely that hospitals would have that information, according to Martin Gallegos, senior vice president of health policy and communications with the Hospital Association of Southern California.
"Hospitals do not ask patients immigration status during the intake for admission," he said. The association also knows of no instances where ICE officials visited hospitals looking for information about residents.
Nonetheless, Apolonio Morales, the political director of the advocacy group Coalition for Humane Immigrant Rights of Los Angeles, said just the presence of ICE on the grounds of hospitals and medical clinics could discourage immigrants from seeking care.
"It still sends a message to the folks that may have family members that are undocumented that are visiting this hospital, or that may be undocumented themselves, that this is not an institution that is a safe institution for them," he said.
California Chief Justice Tani Cantil-Sakauye raised similar concerns about the presence of ICE agents in state courthouses. In March, the chief justice wrote to U.S. Attorney General Jeff Sessions and then-Homeland Security Secretary John F. Kelly asking they stop federal agents from "stalking courthouses" to make arrests of immigrants living in the country illegally.
Legal advocates said at the time that some immigrants may avoid the court and local public safety agencies if they thought they might be picked up by ICE. Courthouses are not considered "sensitive locations" under ICE policy.
ICE spokeswoman Virginia Kice said the aim of Homeland Security outreach effort is to partner with "prominent entities in the public and private sectors to identify and defuse potential threats before they materialize into real-world incidents."
Kice said that statistics on how often ICE officials go into hospitals and clinics were not readily available.