California Faces Limits as It Directs Health Facilities To Push Back on Immigration Raids

In recent months, federal agents have camped in the lobby of a Southern California hospital, kept patients detained — sometimes chained — in hospital rooms and chased an immigrant landscaper through a surgical center.

U.S. Immigration and Customs Enforcement agents also showed up at community clinics. Health providers say officers tried to enter a parking lot housing a mobile clinic, waved a machine gun in front of clinicians serving the homeless and dragged a bystander into an unmarked car outside a community health center.

In response to such immigration enforcement activities in and around clinics and hospitals, Democratic Gov. Gavin Newsom last month signed SB 81, which prohibits medical facilities from allowing federal agents without a valid search warrant or court order to enter private spaces, including places where patients receive treatment or discuss health matters.

But even though the bill has received broad support from medical groups, health care workers and immigrant rights advocates, legal experts say California cannot prevent federal authorities from carrying out their duties in public places, including hospital lobbies and general waiting areas, health care facility parking lots and surrounding neighborhoods — places where recent ICE activities have sparked outrage and fear. Previous federal restrictions on immigration enforcement in or near sensitive areas, including health care facilities, were rescinded by the Trump administration in January.

“The problem states are facing is the supremacy clause,” said Sophia Genovese, a supervising attorney and clinical instructor at Georgetown Law. She said the federal government has the right to conduct law enforcement activities and there are limits to what the state can do to stop them.

California law designates a patient’s immigration status and place of birth as protected information, which, like medical records, cannot be disclosed to law enforcement without a warrant or court order. And it requires health care facilities to have clear procedures for handling requests from immigration authorities, including training staff to immediately notify a designated administrator or legal counsel if officers request to enter a private area or review patient records.

Several other Democratic-led states have also passed laws to protect patients in hospitals and health centers. In May, Colorado Governor Jared Polis signed the Protect Civil Rights Immigration Status bill, which penalizes hospitals for illegally sharing information about people in the country and prohibits ICE agents from entering private areas of health care facilities without a court warrant. In Maryland, a law requiring the attorney general to create guidelines to prevent ICE from entering health care facilities took effect in June. New Mexico instituted new patient data protections and Rhode Island banned health care facilities from asking patients about their immigration status.

Republican-led states have aligned themselves with federal efforts to prevent health spending on immigrants without legal authority. These immigrants are not eligible for full Medicaid coverage, but states bill the federal government for emergency care in some cases. Under a law that took effect in 2023, Florida requires hospitals that accept Medicaid to inquire about a patient’s legal status. In Texas, hospitals must now report how much they spend treating immigrants without legal authorization.

“Texans should not have to bear the burden of financially supporting the medical care of illegal immigrants,” Gov. Greg Abbott said in issuing his executive order last year.

California’s efforts to curb enforcement of federal laws come as the state, where more than a quarter of residents are foreign-born, has become the target of President Donald Trump’s immigration crackdown. Newsom signed SB 81 as part of a bill banning immigration agents from entering schools without a warrant, requiring law enforcement officers to identify themselves and prohibiting officers from wearing masks. SB 81 passed on a party-line vote without formal opposition.

“We are not North Korea,” Newsom said during a bill signing ceremony in September. “We are fighting against these authoritarian tendencies and actions of this administration.”

Some bill supporters and legal experts have said the California law can prevent ICE from violating patients’ existing privacy rights. These include the Fourth Amendment, which prohibits warrantless searches in places where people have a reasonable expectation of privacy. Valid warrants must be issued by a court and signed by a judge. But ICE agents frequently use administrative warrants to try to gain access to private areas they don’t have authority to enter, Genovese said.

“People don’t always understand the difference between an administrative warrant, which is a meaningless piece of paper, and an enforceable judicial warrant,” Genovese said. Judicial warrants are rarely issued in immigration cases, she added.

The Department of Homeland Security said it would not enforce California’s mask ban or identification requirements for law enforcement officers, calling them unconstitutional. The department did not respond to a request for comment on the state’s new rules regarding health care facilities, which took effect immediately.

Tanya Broder, senior attorney at the National Immigration Law Center, said immigrant arrests at health care facilities appear relatively rare. But the federal decision to roll back protections around sensitive areas, she said, “has generated fear and uncertainty across the country.” Most of the highest-profile stories about immigration agents in health care facilities have taken place in California, largely involving detained patients brought in for treatment.

The California Nurses Association, the state’s largest nurses union, co-sponsored the bill and raised concerns about the treatment of Milagro Solis-Portillo, a 36-year-old Salvadoran woman who was under 24-hour surveillance by ICE at Glendale Memorial Hospital over the summer.

Union leaders also condemned the presence of agents at California Hospital Medical Center, south of downtown Los Angeles. According to Anne Caputo-Pearl, a labor and delivery nurse and chief union representative at the hospital, officers brought in a patient on Oct. 21 and stayed in the patient’s room for nearly a week. The Los Angeles Times reported that a TikTok streamer, Carlitos Ricardo Parias, was taken to the hospital that day after being injured during an immigration enforcement operation in South Los Angeles.

ICE’s presence was intimidating to nurses and patients, Caputo-Pearl said, and led to restrictions on visitors to the hospital. “We want better clarification,” she said. “Why are these agents allowed to be in the room?

Hospital and clinic officials, however, said they are already following the law’s requirements, which largely reinforce detailed guidelines issued by state Attorney General Rob Bonta in December.

Los Angeles County’s community clinics, which serve more than 2 million patients a year, many of them immigrants, have been implementing the attorney general’s directives for months, said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles County. But she said the law should help ensure uniform standards across healthcare settings that clinics refer to and reassure patients that procedures are in place to protect them.

Still, it can’t prevent immigration raids in the broader community, making some patients and even health care workers afraid to venture outside, McCarthy said. Some incidents have occurred near clinics, including the arrest of a passerby outside an East Los Angeles clinic, which a security guard filmed, she said.

“Clinic staff members asked us, ‘Is it safe for Me go out?’” she said.

At St. John’s Community Health, a network of 24 community health centers and five mobile clinics in South Los Angeles and the Inland Empire, CEO Jim Mangia acknowledged that the new law can’t prevent all immigration enforcement activity, but he said it gives clinics a tool to push back if agents show up, something his staff has already had to do.

Mangia said St. John’s staff had two meetings with immigration officials over the summer. In one, he said, staff blocked armed officers from entering a closed parking lot at a drug and alcohol rehab center where doctors and nurses were seeing patients in a mobile clinic.

Another incident occurred in July, when immigration agents descended on MacArthur Park on horseback and in armored vehicles, part of a show of force by the Trump administration. Mangia said masked police officers dressed in full tactical gear surrounded a street medicine tent where St. John’s providers were caring for homeless patients, yelled at staff to get out and pointed a gun at them. Providers were so shaken by the episode, Mangia said, that he had to bring in mental health professionals to help them feel safe returning to the streets.

A DHS spokesperson told CalMatters that in rare cases where agents enter certain sensitive locations, agents would need “approval from a secondary supervisor.”

Since then, St. John’s has stepped up its efforts to provide support and training to staff and offered patients who are afraid to go out the option of in-home medical visits and grocery deliveries. Patient fears and ICE activity have declined since the summer, Mangia said, but as DHS plans to hire 10,000 more ICE agents, he doubts that will last.