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I missed the vaccination I was a child. I’ve skipped blood sugar check. Drugs abandoned at the pharmacy.
These have been noticed by medical disruption providers since immigration and customs enforcement operations began earlier this month in Southern California.
Throughout the region, once busy parks, shops and businesses have been empty with undocumented residents and their families hollowing out their homes in fear. With rumors of immigrant arrests swirling around clinics and hospitals, many patients have also opted to skip chronic care management visits and routine childhood consultations.
In response, local federally qualified health centers (an institutions that receive federal funds and are required by law to provide primary care regardless of their ability to pay — are rushing to organize virtual appointments, domestic chores and pharmacy delivery for patients who are unable to safely go out in public places.
“We see a very terrifying and chaotic environment that makes it extremely difficult to meet the health care needs of our patients,” said Jim Manzia, president of St. John’s Community Health, which provides medical, dental and mental health care to more than 100,000 low-income patients each year in Southern California.
Before the attack, the system’s clinic network had recorded a no-show rate of about 9%, Mangia said. Over 30% of patients have been cancelled or not shown in recent weeks. In response, the organization launched a program called Healthcare without fear of providing virtual and home visits to patients concerned about arrest prospects.
“When we miss an appointment and call patients back without calling, overwhelmingly they tell us that they don’t come out because of the ice,” said Manzia, who estimates 25% of the clinic’s patient population is undocumented. “People are missing out on a fairly substantial health care appointment.”
A recent survey of patients no-shows at Los Angeles County non-profit clinics found no universal trends among 118 members of Community Clinic ASSN. President Louise McCarthy said. Some clinics have seen Jump because they missed their appointments, while others have not seen the change. She noted that the data does not show the number of patients who have chosen to convert scheduled in-person visits to telehealth, so she does not need to leave the house.
Patients also expressed concern that health services use could be a target. Earlier this month, the Associated Press reported that the U.S. Department of Health and Human Services had shared personal data from Medicaid registrants with the U.S. Department of Homeland Security, including the status of immigration. There are no specific enforcement actions that are directly linked to the data.
“The level of uncertainty and anxiety that is happening now is beyond pale,” McCarthy said, both patients and staff.
County-run LA General Medical Center issued a statement Thursday rebutting a report that federal authorities had carried out enforcement activities at the Downtown Trauma Center. No immigration-related arrests have been reported at county health facilities, but “the mere threat of immigration enforcement near medical facilities is damaging and putting the health of the community at risk,” the statement said.
Los Angeles County is one of the providers working to expand home care options, including drug delivery and nurse advice lines for people who are reluctant to come in person.
“But not all medical appointments and conditions can be addressed remotely,” the spokesman said. “We urge those who need to be careful not to delay.”
The provider expressed concern that a lack of preventive care appointments could lead to emergencies that threaten patients’ lives and lead to further stress on public resources. Staff from the LA Regional Clinic group said preventive care “keeps our community healthy and benefits everyone in Los Angeles.” He asked that employers not be named for fear of attracting attention to the patient population.
Now, ignoring care, he said, “In the long run, everyone will sacrifice more money.”
St. John’s medical director Dr. Bucola Orsanya said there is a high chance that hypertensive patients skilled in appointments for blood pressure monitoring will likely suffer a heart attack and be brought to the emergency room in the future.
“if [people] They can’t get their medicine and they can’t follow up. So, a chronic condition that is managed and properly controlled will only deteriorate,” she said.
The provider is already watching that shift. When the health team recently visited one diabetic patient at home, they discovered her blood sugar level was sky high, Mangia said. She told the team that she only consumed tortillas and coffee in the past five days, rather than risking her trip to the grocery store.
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