Immigrant issues: Health and safety

The AMA has been, and continues to be, deeply committed to ensuring the health and safety of all individuals regardless of immigration status. We have been vocal, urging the Administration and Congress to work with the AMA and other medical and mental health care experts to develop policies that ensure the health of children and families is protected throughout the immigration process.

On April 23, 2020, the AMA wrote a letter to the Acting Secretary of the Department of Homeland Security (DHS) and the Inspector General of the DHS calling for an investigation into reports that pregnant women seeking asylum in the United States are being denied timely access to health care by U.S. Customs and Border Protection (CBP) Agents.

In addition, the letter recommended that CPB develop, adopt and publish explicit policies that ensure adequate, timely medical care for pregnant women in the agency’s custody in consultation with independent medical experts and rights stakeholders, and that reflect best practices recommended by medical specialty societies.

Moreover, the letter requested that the Inspector General assess whether CBP oversight and disciplinary mechanisms are sufficient to ensure that CBP officials are held accountable for all instances of detainee mistreatment or neglect and to ensure that dangerous, abusive, or otherwise unfit CBP employees are removed promptly from duty. Finally, the letter requested that DHS refrain from detaining pregnant women during the COVID-19 pandemic.

• On Jan. 12, 2022, the AMA sent a letter responding to a Request for Information (RFI) from the Office of Science and Technology Policy (OSTP) regarding public and private sector uses of biometric technologies, published in the Federal Register on Oct. 8, 2021 (86 Fed. Reg. 56300). The letter focused on three of OSTP’s requested topics: (1) descriptions of the use of biometric information for recognition and inference; (2) the exhibited and potential harms of a particular biometric technology; and (3) the exhibited and potential benefits of a particular biometric technology.
• On Dec. 21, 2020, the AMA sent a letter to the DHS opposing a proposed rule entitled “Collection of Biometric Data From Aliens Upon Entry to and Departure From the United States” via Docket Number USCBP-2020-0062. DHS proposed to implement a national biometric entry and exit program, focusing on the use of facial recognition technology, which also would permit the collection of biometric information beyond photographic images. The AMA urged DHS to withdraw its proposal until the data of participants can be adequately protected, and the accuracy of facial recognition technology has increased such that it does not contain racial, age and gender biases.
• On Oct.13, 2020, the AMA sent a letter to DHS urging the agency to withdraw its proposed rule on Collection and Use of Biometrics by U.S. Citizenship and Immigration Services (USCIS). There were multiple health, ethical and social equity-related issues highlighted in the letter particularly as it relates to the mandatory collection of DNA from immigrants and their U.S. sponsors. The AMA is concerned about the scientific rigor of biometric data processing at DHS facilities, the ability to collect these samples with informed, non-coercive consent, and maintaining data privacy.

The U.S. Department of Justice (DOJ) issued a proposed rule to begin collecting DNA samples from hundreds of thousands of immigrants each year and to enter the results into a national criminal database.

On Dec. 17, 2019, in accordance with policy adopted during the AMA 2019 Interim Meeting, the AMA strongly urged the DOJ not to expand the use of DNA-sample collection in its proposed rule.

• On Oct. 10, 2022, the AMA sent a letter to DHS and HHS urging the Administration to increase research and patient-centered mental health treatment for refugee and migrant populations and urging the Administration to provide safer medical practices and protections for migrant women.
• On Sept. 24, 2021, the AMA sent a letter urging the U.S. Department of Homeland Security (DHS) to ensure the health and well-being of all individuals and their families seeking asylum in the United States, including the Haitian refugees that were at the U.S. southern border.
• On July 15, 2021, the AMA sent a letter urging  the U.S. Department of Homeland Security (DHS) and U.S. Customs and Border Protection (CBP) to preferentially use Alternative to Detention (ATD) programs that respect the human dignity of immigrants, migrants, and asylum seekers who are in the custody of federal agencies.
• On March 31, 2021, the AMA sent DHS a letter identifying several regulations relating to immigration that the AMA wanted the Administration to review and revoke, modify, or supersede.
• On Sept. 23, 2020, the AMA sent a letter addressed to Immigration and Customs Enforcement, the Department of Homeland Security, and the Office of Inspector General urging for a thorough investigation into complaints concerning detained immigrants’ substandard living conditions and improper health care, including allegations of inadequate informed consent practices.
• On Sept. 22, 2020, the AMA joined 12 other health care organizations in raising concern surrounding CBP’s contract for medical services which was set to expire on Sept. 29, 2020. As of Sept. 22, CBP had not issued a solicitation for a new contract and the AMA noted apprehension surrounding the administration’s lack of action, leaving less than a month for CBP to award a new contract for medical services. In part due to these advocacy efforts, CBP awarded a contract to Loyal Source Government Services LLC (the current contractee) in the amount of $67.9 million for “medical evaluation/screening” through February 24, 2021 with the possibility of extending it to Sept. 29, 2022.
• In July 2019, in accordance with current AMA policy, the AMA called on the DHS and CBP to address the condition of their facilities at the southern border, which are inconsistent with evidence-based recommendations for appropriate care and treatment of children and pregnant women. The AMA also provided a written statement to the House Committee on Oversight and Reform (COR) in advance of their hearings entitled, “Kids in Cages: Inhumane Treatment at the Border,” and “The Trump Administration’s Child Separation Policy: Substantiated Allegations of Mistreatment.” Additionally, the AMA drafted its own letter and signed on to two letters of support for H.R. 3239, the "Humanitarian Standards for Individuals in Customs and Border Protection Custody Act," along with 13 other health care organizations (letter one to Chairmen and Ranking Members and letter two to Speaker of the House Pelosi).
• On Dec. 18, 2018, the AMA joined 12 other medical associations and specialty organizations in a sign-on letter strongly urging the DHS to implement specific meaningful steps to ensure that all children and pregnant women in CBP custody receive appropriate medical and mental health screening and necessary follow-up care by trained providers.
• On July 24, 2018, several national health care organizations, including the AMA, sent letters to the U.S. House and U.S. Senate asking for oversight hearings on the care given to families in DHS-run detention facilities.
• On June 19, 2018, the AMA sent a letter to DHS, the Department of Health and Human Services (HHS) and the DOJ, consistent with AMA policy adopted during the 2018 Annual Meeting of the AMA House of Delegates, urging the federal government to withdraw its zero tolerance policy.

• On Feb. 27, 2023, the AMA provided comments in opposition to the Interim Final Rule on Security Bars and Processing; Delay of Effective Date (IFR). While the AMA appreciated the Department’s desire to delay implementation of the Security Bars rule, we strongly urged for the rule to be rescinded instead of delayed. The implementation of the Asylum Processing IFR made implementation of the Security Bars rule obsolete.
• On Feb. 2, 2022, the AMA sent a letter opposing an Interim Final Rule (IFR) -- Docket Number USCIS 2020-0013. The AMA expressed concern that the IFR would legitimize discrimination against vulnerable asylum seekers, create a right to refuse to provide certain treatments or services, and arbitrarily discriminate against individuals based on a border patrol agent’s uninformed medical determination or an individual’s country of origin.
• On Oct. 19, 2021, the AMA sent a letter commenting on the Procedures for Credible Fear Screening and Consideration of Asylum, Withholding of Removal, and Convention Against Torture (CAT) Protection Claims by Asylum Officers proposed rule. The AMA applauded the proposals under this rule to expand the power of asylum officers, increase the use of parole in the immigration system, and increase funding for the immigration system. However, the AMA recommended that asylum officers receive extensive training and guidelines to ensure they are making accurate asylum and CAT determinations and believes that asylum and CAT applications should continue to receive a full hearing from an Immigration Judge if the application is denied by an asylum officer.
• On April 9, 2021, the AMA sent a letter to DHS, ICE, and DOJ providing comments in opposition to Docket Number USCIS 2020-0013 (Interim Final Rule). The AMA strongly urged DHS, ICE, and the DOJ to rescind the IFR on the grounds that it would place asylum seekers in peril and provide the DHS and border patrol agents with unwarranted and heightened authority that represents an ineffective way to protect public health while reducing barriers for noncitizens seeking protection in the United States.
• On Aug. 5, 2020, the AMA submitted a formal comment letter to DHS, ICE, and the DOJ urging the Administration to withdraw USCIS 2020-0013.
• On Sept. 13, 2019, the AMA sent a letter urging the administration to allow asylum-seekers to receive all medically-appropriate care, including vaccinations, in a patient-centered language, and culturally appropriate way upon presentation for asylum regardless of country of origin.

• On March 10, 2020, the AMA sent a letter to ORR within the U.S. Department of Health and Human Services (HHS) urging the Administration to protect the confidentiality of medical and psychological records, as well as any social work case files, of undocumented minors with the U.S. Department of Justice and the U.S. Department of Homeland Security (DHS) during immigration court cases and when making legal residency determinations, including for undocumented minors seeking asylum.
• On Sept. 18, 2019, the AMA submitted a letter to the U.S. House Committee on Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies regarding the hearing entitled, “Oversight Hearing: Mental Health Needs of Children in HHS Custody.” The AMA voiced our concern that with the opening of additional ORR facilities, immigrant minor children, in the custody of ORR could be administered psychotropic drugs despite the lack of evaluation by appropriate medical personnel, and potentially without parental or guardian consent or court order when the child is in no imminent danger to self or others, in violation of applicable laws.

Learn about the AMA's advocacy efforts related to:

• Extension of family detention
• The public charge and the presidential proclamation
• Nonmilitary deferred action
• Deferred Action for Childhood Arrivals (DACA)
• Visa and green card challenges