Considerations for Care of Patients in Immigration and Customs Enforcement (I.C.E.) Custody

Key Message : We present a case of a patient under I.C.E. custody and guidelines co-developed by our interdisciplinary palliative care team to address challenges associated with I.C.E. presence at the bedside. We hope the guidelines presented in this session provide a practical framework for healthcare teams caring for patients under similar circumstances.

Abstract: Across the United States, caring for patients who have been detained by law enforcement presents numerous challenges related to patient communication, care logistics, and coordination with the detaining entity1. The involvement of Immigration and Customs Enforcement (I.C.E.) is associated with additional complicating factors in the current political climate. Existing guidelines addressing I.C.E. presence in healthcare facilities predominantly focus on privacy and defining law enforcement access to areas within hospitals rather than promoting best practices for care provision2. Because of the strengths of palliative care as a patient-centered, holistic, and multidisciplinary specialty, we are uniquely poised to develop and advocate for institutional policies to protect our patients.

We present a case of a patient under I.C.E. custody whose care was complicated by the presence of I.C.E. at the bedside and our strategies to promote the best interests of the patient, family members, hospital staff, and other patients/families in proximity, including the establishment of a functional professional relationship with I.C.E. During this patient's hospital stay, an interdisciplinary palliative care team co-developed communication guidelines for medical teams, unit staff, and hospital administrators to advocate for the optimization of these concurrent interests. These guidelines considered several important challenges in the provision of this patient’s care, including: advance care planning in the setting of possible deportation to a variety of possible global destinations; the need to adjust information gathering to protect patient confidentiality as well as family safety; the legal requirements of operating within limitations set by the detaining agency while also accounting for hospital policies; and the need to provide staff support and safety in a uniquely distressing situation. We hope that the guidelines presented in this session provide a practical framework to empower healthcare teams to provide high-quality, systems-informed care for patients as they navigate serious illness under extraordinarily difficult social circumstances.

References: 1. Chao, S., Weber, W., & Iserson, K. V et al. (2024). Best practice guidelines for evaluating patients in custody in the emergency department. JACEP Open, 5(2). https://doi.org/10.1002/emp2.13143
2. Know your rights: Health Care Providers & Immigration Enforcement. National Immigration Law Center. (2025, January 24). https://www.nilc.org/resources/healthcare-provider-and-patients-rights-imm-enf/