Undocumented Patients in the Emergency Department

Challenges and Opportunities

Shamsher Samra, MD, MPhil; Breena R. Taira, MD, MPH; Erika Pinheiro, JD, MPP; Rebecca Trotzky-Sirr, MD, MS Eng; Todd Schneberk, MD, MSHPM, MA


Western J Emerg Med. 2019;20(5):791-798. 

In This Article


" The physicians are the natural attorneys of the poor, and the social problems should largely be solved by them."
Rudolf Virchow

The subject of citizenship and legality of populations is complex, contentious, and dynamic. It is clear that lack of citizenship negatively impacts access to healthcare and health. Similarly, the idea of "illegality of persons" contradicts the professional and societal obligations of healthcare providers. The cases highlighted here illustrate how existing systems fail to meet the needs of undocumented patients. We hope this primer informs clinicians in the ED about the multiple levels of barriers undocumented patients face and suggests potential provider- and system-level changes to counteract exclusionary policies and promote health equity. As is often the case, it falls upon healthcare providers to transcend existing norms to secure the medical and structural conditions requisite to the health of our patients.