Physicians Caring for Migrants Are 'Screaming Into the Void'

Usha Lee McFarling, MA

December 02, 2019

The Fallout on Physicians

When she's not working a shift in the ED, Theresa H. Cheng, MD, JD, is either traveling to Tijuana to help provide care for migrants congregated there, visiting detention facilities, or volunteering at the asylum clinic at the University of California, Los Angeles. "While all this is going on," said Cheng, "I can't just sit still."

Cheng's young medical career is already filled with disturbing cases: migrant women who have been gang-raped and men who have been flagrantly tortured. Recently, a paramedic called her ED at UCLA from a construction site in regard to a worker who had been crushed by heavy machinery and was unable to walk but refused to get into an ambulance. "I spoke with the patient on the radio. He said he was too scared to come in because he was undocumented," said Cheng.

Cheng, who holds both medical and law degrees, was motivated by the border crisis to reinstate her state legal license so that she could better assist asylum seekers.

Some of those whom Cheng is helping have fled their countries with literally nothing, including evidence or documentation of why they fled. They often fear sharing their experiences of abuse at the hands of gangs in courtrooms as they seek to make their case for asylum in the United States. "We use their bodies and interpret scars and burns as pieces of evidence," Cheng explained, arguing that physicians need more tools and training to better assist this vulnerable population.

Bryn Esplin, JD, a clinical bioethicist at the University of North Texas Health Science Center in Fort Worth, is working to give medical students some of those tools. Esplin, who often works directly with detainees and asylum seekers who have difficulty accessing treatment or contacting family members while hospitalized, said the sacred duty of physicians is undermined when doctors are pressured to release sick patients into detention too soon or examine migrants while shackled or with agents present.

It's a thorny issue of dual-loyalty, she said, where physicians can become conflicted between providing the best care and ensure patient privacy, and complying with law enforcement directives. "These are not issues of activism or political rhetoric," said Esplin. "It is really about patient safety and the professionalism of the medical community." The AMA's Declaration of Professional Responsibility, she notes, contains this statement: "Humanity is our patient."

Many physicians struggle, Esplin said, because their employers have no policies in place on how to protect the rights of migrants or use rules developed for the treatment of prisoners.

Altaf Saadi, MD, agrees that hospitals and healthcare facilities need an entirely new and more nuanced set of tools to deal with migrant patients. Saadi struck a nerve with an opinion piece she coauthored about the fear among undocumented patients that keeps them from seeking medical care altogether.

Saadi, a neurologist at Massachusetts General Hospital who immigrated from Iran at age 10, said the current crisis has made a chronic problem worse. "One of the things that often gets missed is that living in fear is not anything new for immigrants," said Saadi. "As physicians, our priority is always helping patients. And taking care of patients means not contributing to their fear."

That fear, which has escalated recently, is palpable in many hospitals, said Robert Rodriguez, MD, an ED physician at Zuckerberg San Francisco General Hospital who published a study that found that high-profile news events relating to immigration kept many immigrants from seeking care at three California EDs, facilities that take all patients regardless of citizenship status or ability to pay.

"EDs are the safety net. If a group of people is suddenly afraid to come, they have nowhere else to go," Rodriguez said. "And if there is this level of fear in San Francisco, Oakland, and LA, all of which are pretty well known as sanctuary cities, we expect that the fear in other places is likely a lot higher."

It's not just patients who are afraid. The advocacy group Physicians for Human Rights recently published a report called "Not in My Exam Room," detailing numerous problems doctors have faced while trying to provide care for immigrant patients, including retaliation from employers and fellow physicians. Said Kathryn Hampton, one of the report's authors, "There are so few protections for providers who do speak out. You see that many of our quotes are anonymous."