In our debut episode, hosts Drs. Ayesha Khan & Quincy Moore along with special guest host Dr. Vibha Gupta sit down with our guests, Dr. Mary Cheffers (LA County), Dr. Todd Schneberk (LA County) and Mrs. Mayra Joachin (Attorney, National Immigration Law Center) to discuss what emergency providers should know about their patients with immigration-related issues.

Objectives:

• Learn the effects of anti-immigrant legislation on seeking care and ED presentation
• Learn barriers immigrants and undocumented patients face in seeking care
• Learn what rights undocumented patients in the ED have
• Learn where you can connect your patients to legal aid and healthcare resources

• Know your options when ICE shows up to your ED

  Resources:

• Community health centers, migrant health centers, and free clinics

  • https://findahealthcenter.hrsa.gov
  • https://www.nafcclinics.org/find-clinic

  • Legal aid

  • Nonprofit organizations that provide low-cost help https://www.immigrationlawhelp.org

  • List of lawyers that provide free services via immigration courts https://www.justice.gov/eoir/list-pro-bono-legal-service-providers
  • Search engine for legal services near you https://www.adminrelief.org
  • American Immigration Lawyers Association’s online directory https://www.ailalawyer.com
  • National Immigration Project of the National Lawyers Guilde https://www.nationalimmigrationproject.org/find.html
  • National Immigration Law Center Health Care Toolkits - https://healthtoolkit.nilc.org

  • How to make sure your ED is safe space

  • Signs / posters / message to patients (in various languages)

  • Know-your-rights cards for patients
  • Designating private and public spaces
  • Make an ED protocol for interaction with ICE authorities
  • Relationship with legal team
  • Transcript

Take-home points:

• All ED docs are going to encounter undocumented immigrants in the ED and in the community

• Understand the barriers to care- much is related to fear

• ED docs can be advocates and create a safe space- create posters, talk to your hospital administration to come up with programs/direct people to resources
• Patients present to the ED more and more critically ill because they delay care
• It is important to note that the protections that HIPAA provides as well as the stance on whether or not it is best to document a patient's immigration status in their medical record is controversial. The NILC states "Providers are strongly encouraged to avoid collecting or recording immigration-related information in the event that they are legally required to disclose their otherwise protected information". For further discussion of this challenging question, please reference the NILC Healthcare Toolkit or your hospital's legal department.

Contributors:

• Vibha Gupta
• Lia Losonczy
• Sonali Gandhi
• Annette Dekker
• Jorge Aceves

Funding Acknowledgment - The development of this video podcast series was supported by a section grant of the American College of Emergency Physicians awarded to the ACEP Social Emergency Medicine Section.