1. Protecting access to healthcare for immigrants
Talking primarily about the community health center context
Gabrielle Lessard

2. context
Longstanding policy of avoidance of health care facilities by immigration enforcement authorities
We have not seen any evidence of enforcement activity in health care settings

3. Protecting access to care At Community health centers
Adopt policies and practices that:
Maximize Fourth Amendment protection against unreasonable search and seizure
Maximize confidentiality of patient information
State health information confidentiality laws, ACA confidentiality provisions

4. Constitutional protection
The 4th Amendment provides constitutional protection against unreasonable search and seizure
What’s unreasonable?
Searches in areas in which one has a reasonable expectation of privacy
Generally must have a warrant to search without consent
No reasonable expectation of privacy in public space
ICE/law enforcement can enter, look at anything ‘in plain view’
Can question persons present
they have a right to remain silent
Reasonable expectation of privacy is subjective – the individual must have the actual expectation and it must be reasonable by societal standards
Can search w/o warrant or consent if they have probable cause that things connected with unlawful activity will be found in a place
Plain view includes hearing sounds audible in the public space even if emanating from a non-public place

5. Maximizing Fourth Amendment protections
Establish a written policy designating areas of the clinic as private
Ex: waiting room is public, all areas beyond waiting room are private
Ex: only patients and people accompanying them are permitted to enter the clinic
Establish policies limiting the materials brought into any public areas of the clinic
Provide posters, know your rights cards and other educational materials advising patients of their rights in interactions with ICE and law enforcement
KYR cards in link at end of preso

6. Maximizing Fourth Amendment protections
4. Designate one or two specific staff members as responsible for handling interactions with law enforcement.
Train them to evaluate the sufficiency of a warrant:
Is it signed by a judge or magistrate?
Does it state the address of the premises to be searched?
Is it being executed during the designated time, if any
Train them to observe law enforcement and to object if their actions exceed those authorized by the warrant
Train other staff to refer law enforcement to them and to refuse to answer law enforcement questions without their authorization
5. Establish a relationship with an immigration lawyer
Immigration lawyer should be able to come to the clinic if there is an ICE/law enforcement action

7. Protecting patient information
HIPAA includes provisions to protect the confidentiality of personal information related to using or paying for health services
Protected personal health information (PHI) includes name, address and social security number
Covered entities subject to HIPAA’s privacy protections include health care providers and health plans
The Affordable Care Act includes provisions protecting the privacy of information provided to healthcare exchanges
States may adopt laws that are more protective of privacy
California Confidentiality of Medical Information Act (CMIA)
HIPAA – health insurance portability and accountability act of 1996

8. Protecting patient information
Personal Health Information may be disclosed without patient consent under certain circumstances, including:
Where the disclosure is required by a court order,
Where the disclosure is required by law, such as where state law makes the health provider a mandatory reporter of abuse of children or vulnerable adults
In some circumstances disclosure is permitted, but not required, including:
Audits and investigations conducted for oversight of the health system
Law enforcement attempts to locate a suspect or missing person
Evidence of crimes committed on the premises
California law makes health provider mandatory reporters In CA, reporting is mandatory for health practitioners who provide health services to a person with injuries they know or reasonably suspect are caused by a firearm or assaultive or abusive conduct, defined to include multiple criminal offenses. Must report to local law enforcement; failure to report is a misdemeanor

9. Protecting patient information
Adopt a policy against disclosing personal health information where such disclosures are permitted, but not required
Establish a relationship with a lawyer who can evaluate the validity of any order for release of information

10. Local policies
Communities can advocates for systems-level policies and expressions of support: Alameda County, California has made a statement that its hospitals are safe spaces and is working on a policy Los Angeles County’s Director of Health Services has put out a message to patients San Francisco Department of Public Health created a post-election webpage and You’re Safe Here! flyer in multiple languages New York City Health + Hospitals has published a powerful message to immigrant consumers

11. Resources from NILC
Immigration Enforcement Know Your Rights Healthcare