Doctors blame aggressive tactics for higher no-show rates and fewer kids getting shots
WASHINGTON — The patient lying before David Hill was in labor, but it was the first time in her pregnancy she had seen a doctor.
It was too late. A stillbirth was inevitable.
Hill, a pediatrician practicing at the time in North Carolina, had been brought in by the obstetrician to make sense of what went wrong and whether it could have been prevented.
“I do not know — because I don’t know the extent of the anomalies — whether that baby could have been saved or whether [the mother] at least could have been prepared for what was likely to happen,” he said.
But Hill and his colleague did have a theory of what went wrong. They have been contending with an increase in patients from immigrant communities avoiding care, including pregnant mothers and parents with sick children — especially after the Trump administration launched its aggressive immigration enforcement actions over the past year.
The doctors didn’t know the immigration status of this patient, and they didn’t ask. She spoke only Spanish and was in a state of profound grief. Still, Hill and his colleagues agreed she was likely among the many patients who have put off care because they didn’t want to risk leaving the safety of their home. “It’s a tragedy for us,” he said.
Doctors nationally are describing harrowing consequences for patients who delayed seeking care or skipped it altogether, including a child who suffered a ruptured eardrum and a patient with a burst appendix. And it’s not just happening in places like Minneapolis where federal enforcement surges are ongoing, doctors and health system leaders told STAT.
The fear, they said, is showing up in the data: significant increases in no-show rates for appointments and drops in the number of vaccines given to immigrant populations. In Dallas, for example, the local health department’s clinics saw a particularly large drop in back-to-school vaccinations for Hispanic children in August 2025 compared to August 2024 — down to nearly 5,800 from 11,500 a year earlier. The health department’s director, Philip Huang, told STAT community outreach teams were repeatedly told by patients that fears of Immigration and Customs Enforcement agents were keeping them away.
The Department of Homeland Security did not respond to a request for comment on the health implications of its agents’ activities.
Providers are redoubling outreach efforts and employing pandemic-era approaches to offer care from afar.
“It has an eerie feeling that there was during the pandemic,” said Bryan Fate, a pediatrician at Children’s Minnesota. “There’s been a huge lapse in care.”
Political problems, pandemic solutions
In Minneapolis, flooded with federal immigration agents over the last month, Children’s Minnesota is offering telehealth options for patients who want to stay home, where law enforcement officers would need a warrant to enter. Demand for grocery boxes through the hospital has skyrocketed, Fate said.
The hospital has dispatched nurses to see newborns of mothers who are too scared to leave home, he said.
“As a clinician, I would feel more comfortable being able to lay eyes on them and examine them and have them come in,” Fate said. “But sometimes you have to do what you can to get the baby seen.”
Other health systems, facing similar challenges for months, have redirected resources.
At St. John’s Community Health in Los Angeles, during intense immigration raids last summer, no-show rates more than tripled, with nearly one in three patients missing appointments. The system rolled out a “Healthcare Without Fear” program, which included home visits and intensive patient engagement, to help reverse the trend.
At nearby Venice Family Clinic, after seeing an increase in no-shows, especially in locations where immigration actions were rumored, leaders changed protocols — reaching patients by phone before appointments and seeing whether they wanted to reschedule or use telehealth instead.
“The whole goal of all that is to try to maintain people’s health as much as we can under challenging situations, under stress, under duress, and try to keep them in care,” said Mitesh Popat, CEO of the clinic.
The Trump administration’s surge in enforcement in California last summer has faded as the headlines about a pugnacious federal force in Minneapolis have dominated. But the anxiety of patients calling into the California clinic hasn’t changed, Popat said: “It creates a culture of fear.”
‘Too scared to leave the house’
In Minneapolis, parents are sending their children to the hospital with neighbors, and staying on the phone as their children are seen, Fate said.
“The parents are too scared to leave the house,” he said.
Many children seem to not be showing up at all.
Each emergency room at Children’s Minnesota usually sees about 130 patients per day, Fate said, but they’re now seeing around 100 — especially unusual through a particularly severe flu season.
When children do arrive, they’re showing up sicker. Admission rates have increased nearly 5 percentage points.
Last week, Fate saw a girl with an ear infection, brought in by the neighbors of the parents. The infection had progressed to the point of rupturing her eardrum, causing fever and pain intense enough to keep her from sleeping.
“The whole side of her cheek was just pussed — because the family was too afraid to take her in,” he said.
Parents have called hospitals asking whether they should risk coming in for babies having trouble breathing, and a patient’s appendix burst because care was delayed, Janna Gewirtz O’Brien, president-elect of the Minnesota chapter of the American Academy of Pediatrics, told reporters last month.
That’s in part because ICE agents have been in and around health centers, she said.
Clinicians also worry about the long-term mental health implications for children of immigration raids.
“Kids’ mental health is as bad as I’ve seen it, even compared to the pandemic,” Fate said. “Kids need safe places, and safe places are no longer safe.”
Teens have been pepper sprayed and tackled in front of their schools, he said, echoing other providers in the area, who reported minors being put in handcuffs facedown near school and taken outside without coats in sub-zero weather.
“Family separation is not a temporary disruption, it is a traumatic event with lifelong consequences,”O’Brien said.
Not every provider is seeing impacts of aggressive immigration enforcement. Providers in some parts of the country, including suburban Michigan, upstate New York, and Utah, told STAT they hadn’t seen immigration enforcement change care in their practices substantially, though they all had heard of colleagues — often those serving large immigrant populations or in communities with a large ICE presence — who were dealing with such challenges.
The administration is targeting health care for immigrants more directly as well. Centers for Medicare and Medicaid Services Administrator Mehmet Oz has rushed highly publicized reviews of states’ use of Medicaid dollars on unauthorized care for immigrants. And the reconciliation bill signed by Trump last year specifically targets federal spending on non-citizens, even those with legal status.
For providers, including Hill, the fallout of such administrative actions can be just as concrete as immigration raids.
“I would challenge the people promoting these policies to tell this mother that the loss of that baby was worth it,” he said. “If they had to walk in that room and speak to her directly, I’d be fascinated to hear what they would say.”