When Hospitals Cave to Trump, Health Workers Must Disobey

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This week, a major private hospital system in New York City, NYU Langone Health, and the country’s largest municipal health system, NYC Health + Hospitals, issued guidance that shocked many of their employees: “You should not try to actively help a person avoid being found by ICE.” Oddly, despite entirely separate administrations and governing rules, internal memos issued to employees at both hospital systems are identically worded and were distributed within a day of each other, according to Crain’s New York, which obtained the memos and broke the stories.
Doctors and nurses universally agree that our most fundamental ethical and professional duty is to care for our patients and protect them from harm. Unfortunately, such idealized visions of ourselves often prove empty, as we are compelled to work inside corrupt U.S. health care institutions that routinely prioritize profit over patients. But so far, compromising our ethical integrity by collaborating with mass arrest and deportation plans is not a level to which we’ve sunk. If we allow hospital administrators to bully us, that may quickly change.
Hospital responses to Immigration and Customs Enforcement threats have major population-level health implications and should be closely scrutinized for this reason alone, but they are also a bellwether of what is to come in terms of resistance to the Trump regime’s broader attacks on vaccines, bodily autonomy, health research and funding, and access to health care.
What makes the guidelines issued by NYU Langone and NYC Health + Hospitals especially foreboding is that both memos directly contravene guidance issued just two weeks ago by the Greater New York Hospital Association, an influential hospital lobby representing nearly 300 hospitals, in response to the Trump administration. Historically, such groups, which exist to advocate for hospitals’ financial interests, are far from progressive or principled in their politics. But guidelines for dealing with ICE if they show up to hospitals have, up to this point, been considered so uncontroversial that even GNYHA’s five-page recommendations provided protocols for using one’s legal rights to prevent entry of ICE agents and to protect patients and co-workers from threats of arrest and deportation. GNYHA also made a point to warn of the “intimidation” tactics routinely used by ICE agents seeking to gain unwarranted access to private spaces, underlining how hospitals and health care workers should be prepared to stand firm in their rights against such actions.
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The memos at NYU Langone and NYC Health + Hospitals also contradict well-established know-your-rights information for health care workers, who have no obligation to cooperate with ICE and, moreover, have a basic ethical responsibility to deny the agency entry to hospitals and clinics.
By law, ICE agents may legitimately demand entry into private spaces only if they can provide a valid judicial warrant. (These private spaces include all waiting and clinical areas of emergency departments and hospitals, where entry for anyone who is not a patient should always be monitored and denied by staff if an individual poses any kind of threat to patients or their families.) This is not the same as the administrative warrants that ICE agents routinely flash as they demand entry. (ICE agents are trained to lie and claim otherwise while also using a variety of other deceptive tactics when attempting to carry out unauthorized searches.) A judicial warrant must be issued by a U.S. District or state court; this should be stated in clear letterhead at the top of a warrant, and the document must specify the exact areas to be searched and particular people or items to be seized. Even if law enforcement has such a warrant, health care workers have no obligation to assist the agents in their search or to provide them with any information.
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If such a situation does arise in which the law gives ICE permission to enter our facilities, we as health care workers will be forced to confront whether our ethical commitments require defiance of the law via acts of civil disobedience—and whether we have the courage and organization to carry them out to fulfill our duties as caregivers. But to date, there have been no public reports that such an admittedly difficult situation has been forced upon health care providers.
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Although this may change, it does not appear that any judge has so far granted a warrant to give ICE the authority to search a medical facility since the Trump administration, on Jan. 21, revoked long-standing rules prohibiting ICE from searching “sensitive locations.” These locations include medical facilities, schools, and places of religious worship—all of which are now, in theory, fair game for ICE raids if agents obtain a judicial warrant in advance of arrival.
Most hospital employees, who are busy spending long hours caring for patients, are not well informed of the legal limits placed on ICE. As a result, they will likely be intimidated and misled by the memos issued by NYU Langone and NYC Health + Hospitals. Rather than focusing on educating health care workers about their rights and the specific situations when ICE agents do in fact have legal justification to search hospitals, the memos emphasize “our obligation to comply with applicable laws and regulations”—but avoid explaining what those are.
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They also include threatening and misleadingly ambiguous lines that are commonplace today in xenophobic propaganda campaigns but unexpected in hospitals: “Please note, it is illegal to intentionally protect a person who is in the United States unlawfully from detention.” The memos omit the essential corollary: It is not illegal to utilize your rights to deny ICE agents access to hospitals or any other private space, nor is it illegal to exercise your right to refuse to speak with or share any information with ICE. In fact, as a health care provider, irrespective of your politics, it’s your duty.
The memos’ ramifications for public health in New York City could be substantial. Unless they are immediately corrected and countered with aggressive public education campaigns, they will undercut health not just for people lacking legal status and the families of those individuals but for the entire region’s population. If immigrant communities have any reason to fear that hospitals and other medical facilities are collaborating with ICE, they will stay away during key moments when health care is essential to both their personal health and public health and safety writ large.
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Children suffering from asthma attacks and elderly people experiencing heart attacks and strokes will die at home rather than get the lifesaving care they need. Members of immigrant families being subjected to severe stress who are enduring mental health crises, such as manic episodes that can pose severe risks to themselves and others around them, will not get the care they require. Babies will be born in dangerous conditions when complicated births require medical attention but families avoid it due to fear; this will lead to preventable infant and maternal mortality. Infectious diseases, from HIV to tuberculosis and other highly infectious respiratory illnesses, will go undetected and spread rapidly among immigrant and broader populations.
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If more hospital executives—who, in my experience, are typically selected for their combination of moral cowardice and shameless avarice—try to force their employees to collaborate with ICE and refrain from protecting patients and co-workers, medical facilities across the country may begin to fall into line with Trump like a row of dominoes.
This is because administrators are afraid that Trump’s team may target the federal funding of any major hospital or research university that resists his plans and does not make public shows of fealty. This anticipatory obedience is reflected in the past week’s abrupt withdrawal of gender-affirming care for trans patients under 19 at several of the most prestigious hospitals in the country, including NYU Langone, despite no legal obligation forcing their hand. It’s also evident in the scrubbing by universities, hospitals, and medical societies of websites, publications, and programs focused on racial and gender health inequalities—the traces of DEI that Trump’s Justice Department threatened in a memo Wednesday to investigate criminally even though such investigations would have no basis in law and should easily be defeated in court.
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In sum, university and hospital administrators across the country are eagerly obeying in advance and offering to the president what they believe he desires. By doing so, they are showing repressive state power just how little institutional resistance it will encounter on their watch. This is effectively inviting the Trump regime to expand its efforts to exert control over our bodies, families, and medical care as well as over our academic research, university policies and funding, and public discourse. Not only does this strategy sacrifice patients and workers, but it will almost certainly backfire for the very same cowardly administrators who are now implementing it.
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If hospital administrators continue to line up behind Trump by now allowing ICE into medical facilities, the implications for public health nationwide could be catastrophic. This is especially true at this particular moment in light of the looming threat of an H5N1 bird flu outbreak that would likely begin among immigrant farmworkers and that could, if not properly monitored and contained, lead to an extremely dangerous epidemic.
For innumerable reasons, we cannot allow ICE operations inside hospitals to become a norm. To prevent this, we cannot simply wait to see what our bosses do. Instead, health care workers should proactively demand that all U.S. hospitals and health systems immediately release public positions vowing to refuse to allow ICE entry to our facilities without an appropriate warrant and to refuse to allow any staff to cooperate with ICE agents. Hospitals should also commit to protecting employees who are targeted or threatened with legal repercussions for protecting their patients or co-workers from ICE while at work.
In a fundamentally intertwined issue, hospitals should simultaneously insist that they will not abandon trans children or patients seeking abortions, regardless of threats from the Trump administration. We cannot allow the violent bigotry of Elon Musk or Donald Trump to override evidence-based, compassionate medical care that supports our patients’ power to shape their own lives. We must not capitulate to the personal ideologies of politicians and their billionaire sidekicks.
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This is simply the right thing to do, but it is also a coordinated move that would serve hospital and university administrators’ self-interest. Acting forcefully and in unison would protect them from retaliation by the Trump administration, which might otherwise seek to threaten their federal funding in order to coerce compliance.
But health care workers cannot wait on our administrators to stand up for us, our patients, and the ethical foundations of medicine and caregiving. We must organize among ourselves.
Despite recent increases in unionization among nurses and doctors that indicate an increasing recognition of the importance of organizing and solidarity, this is far easier said than done.
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Organizing begins in small acts of everyday care for and mutual aid of one another, by which we build trust and solidarity within our professional ranks and broader communities. It entails making clear to one another where our commitments lie and educating one another on our rights and collective plans for responding when ICE shows up at our hospitals or when administrators threaten one of us. From these elementary acts, we can begin to build toward collective organization, which enables acts of defiance and effective delivery of our demands at scale.
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One potentially powerful tool that then becomes a viable tactic is a billing strike, wherein entire teams of physicians, nurses, and support staff refuse to submit or process any insurance claims for as long as administrators enforce policies that contradict our ethical obligations. Denying the flow of revenue to a hospital can quickly disrupt its operations and force leadership to change policies that endanger patients or require staff collaboration with harmful state actions.
We can also practice a specific form of civil disobedience, called documentary disobedience, to avoid fueling oppressive practices by either withholding or altering documentation in ways that protect patients’ identities and specific treatments, such as gender-affirming care and abortions. One of the most pivotal sites for doing so again pertains to billing. A strategy for this was first proposed by the physician and bioethicist Robert Macauley in 2005 as a means of forcing the U.S. government to provide universal health care. I revisited his strategy at length after the Dobbs ruling in 2022, arguing that doctors should use our control over billing as a means by which to subvert abortion bans and protect rights to reproductive care and bodily autonomy.
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Crucially, such tactics depend upon collective buy-in and careful preparation. We must work together—across roles, departments, and disciplines—to share resources and skills, establish covert communication channels, and collect legal and financial support for targeted individuals when necessary. Although we must know our rights and leverage every legal measure we can to protect our patients and one another, the reality is that neither our bosses nor the law is going to save us. We must instead look to one another and build solidarity as workers devoted to caregiving and the responsibilities it entails, remembering always that our guiding ethical obligations must be to the care of our patients and one another, not obedience to rules or regulations.
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As a nurse at NYU Langone told Crain’s, on condition of anonymity: “Most people I know feel it’s part of our job to treat people from other countries compassionately, whether or not they are here legally. … Obviously if ICE was there we would try to protect our patients from them.” Similarly, New York Doctors, a coalition that includes Health + Hospitals physicians, condemned the hospital system’s memo on ICE as “immoral messaging” and insisted, as we all should, “It is our duty to protect our patients, even if hospitals do not back us up.”
It is vital that health workers hold firm to this duty and push back against encroachment by repressive authorities—those inside and outside our hospitals and universities.