When a man in the custody of Immigration and Customs Enforcement, who had metastatic cancer, was brought to a hospital in Houston, a doctor was not able to conduct a proper examination. ICE would not let the doctor remove restraints that ran across his body, and he died after a few weeks.

In another case, a doctor asked ICE agents to remove shackles from a patient, who was critically ill. The agents would provide no information on why the restraints were necessary. “I couldn’t think of the rationale of chaining someone who is so sick he almost died,” the doctor recalled.

The two examples represent some of the cruelty individuals are experiencing as President Donald Trump’s administration carries out and intensifies a harsh anti-immigration policy. They were highlighted in a report from the Physicians for Human Rights (PHR) on how attacks on immigrants are making it difficult for medical professionals to provide patient care.

ICE and Customs and Border Protection (CBP) “refuse to disclose information about detention sites, which contributes to a lack of accountability for violations.” PHR was unable to determine how frequent certain incidents are.

Regardless, PHR’s report offers a portrait that shows how U.S. immigration enforcement has become savage in its implementation. It is based on interviews with medical professionals from June to September 2018.

“The disruption of medical care by U.S. immigration enforcement officers is deterring some patients from seeking medical care out of fear of coming in contact with immigration officials, thereby putting their health at risk,” said Kathryn Hampton, who is a network program officer with PHR. “It is the ethical imperative of medical professionals to treat patients according to evidence-based medical practice.”

Enforcement agents or detention officers deliberately undermine the privacy rights of patients in custody. “In a Texas gynecological office, staff called local authorities after they suspected that an undocumented patient’s identification was fraudulent, potentially violating health privacy law. The staff led the patient to an exam room, where sheriff deputies arrested her and reportedly threatened deportation.”

Medical professionals allege that information shared by “unaccompanied children in therapy sessions” was “accessed by immigration authorities.” Statements by children were “used as evidence in immigration court hearings.” What children share privately became part of the government’s case for deportation or “higher levels of detention.”

“It is unclear whether the Health Insurance Portability and Accountability Act (HIPAA) protects the children in this situation,” the report states. “However, the disclosure of such information raises ethical concerns about the privacy of those interactions with vulnerable children, especially if the medical professionals are aware that the information will be used against the child’s best interests.”

The presence of immigration enforcement in medical facilities discourage patients from seeking medical treatment or even urgent care. One physician in Los Angeles shared there was a man whose father had cardiac arrest. “By the time he brought his father to the hospital, he had died. He stated he was scared to [bring his father] to the hospital.”

“One patient, Ahmed, avoided going to the hospital out of fear of immigration repercussions, despite his need for urgent care,” according to the report. Ahmed nearly died.

“People without papers, they don’t go to the doctor unless it’s really serious. So, by the time they end up at the hospital, they’re dealing with a physical crisis, job insecurity, mental health issues, and emotional trauma,” a health professional told PHR.

This generates “dual loyalty pressures” for medical professionals, who have a “duty to their patients.” Government directives create “moral distress.” Doctors recognize that they must provide non-prejudicial care and protect basic patient rights. But ICE and CBP require the presence of guards during evaluations of patients, resulting in feelings of powerlessness.

“Medical staff report feeling too intimidated by the armed agents to stand up to ICE or CBP enforcement actions against their patients, or to face hospital administration that is unwilling to become involved when clinicians advocate on the patient’s behalf.”

Several professionals suggested the government is violating what is called the “Sensitive Locations” policy. Apparently, ICE and CBP are not supposed to conduct enforcement operations at medical facilities unless there are “exigent circumstances.”

In one outrageous and well-known case, CBP officials clearly violated their policy by detaining Rosa Maria Hernandez, a 10 year-old suffering from cerebral palsy. She needed emergency gallbladder surgery, and officials ignored the advice of doctors who urged CBP to discharge her to her family. They took her to a juvenile detention facility.

“Patients have the right to be treated by a physician who is free to make decisions about ethical clinical treatment without outside interference,” concluded Hampton. “We must make sure that medical facilities adopt policies that protect both physicians and patients in situations that threaten those ethical commitments.”