California health care facilities must be sanctuaries from ICE | Opinion

Last July, reports that U.S. Immigration and Customs Enforcement (ICE) agents and contractors had remained inside Glendale Memorial Hospital for over two weeks alarmed many Californians. The incident vividly showed how easily health care settings can become sites of immigration enforcement.

As a physician who has practiced for more than 20 years, I believe hospitals and clinics should be places of care — not places where people are tracked, monitored or detained.

This incident followed the federal administration’s decision to end the sensitive locations policy in January 2025, which had discouraged ICE from entering health care settings. California responded with Senate Bill 81, signed into law last September. Authored by California State Sen. Jesse Arreguín, D-Oakland, SB 81 strengthens protections in health care settings by addressing facility access and patient privacy.

The law classifies immigration status and place of birth as medical information under state law and restricts health care facilities from sharing that information with ICE unless required by a valid judicial warrant or court order. It also requires health care facilities to create nonpublic spaces that ICE cannot enter without a valid judicial warrant or court order.

At the same time, a separate fight about ICE’s access to health-linked data was unfolding: Last June, California and a coalition of states sued the federal government after learning that the Department of Health and Human Services had shared Medicaid enrollment identifiers, such as addresses, with the Department of Homeland Security. A subsequent court order has since limited what can be shared in the states that sued while the case proceeds.

For now, the Department of Health and Human Services cannot share detailed, sensitive medical information from Medicaid, nor data about U.S. citizens and documented immigrants in those states.

Medicaid enrollment data is only one pathway. Pharmacy records and location data sold to ICE by data brokers can also expose people to ICE enforcement without their knowledge. Most of us have no idea these pathways exist. Many also do not know that Palantir, which contracts with ICE, also contracts with multiple major health care systems. That overlap raises ethical questions about which vendors health care systems select, what patients are told and how patient data is protected.

As a primary care and HIV physician, I sit across from patients who need to trust me with information that could upend their lives if exposed: an undocumented immigrant asking for HIV PrEP; a woman disclosing her HIV status for the first time; a patient seeking treatment for substance use.

Federal law may protect the medical records held by health care providers and insurers, but it does not protect much of the data trail around them. SB 81 is a start, but gaps remain. Closing them requires data sanctuary policies that go beyond federal law.

California can take three additional, practical steps to help close these gaps:

• Require health care systems that receive state dollars to map where patient data goes, including to outside companies, and publicly report what they find.
• Set contracting rules that exclude vendors that also do business with ICE because of the ethical conflict and potential privacy-related risks.
• Require clear notices for patients that explain what data is collected, what outside companies have access to their data and what legal process is required before the health care system can share their information with ICE.

Patients and communities can play a direct role. Ask your clinic: “What happens to my data beyond this visit? Do you have policies that protect it from ICE?” Ask your hospital whether they contract with companies that also work with ICE. These questions keep people informed and create pressure for systems to change.

ICE in patients’ rooms can be resisted, and the data pathways that can expose patients to ICE can be closed, helping to ensure that health care settings remain places of care.

Oni Blackstock, MD, MHS, is a physician-researcher, founder, executive director of Health Justice and a public voices fellow on technology in the public interest with The OpEd Project.