The Department of Homeland Security’s Operation Metro Surge may be winding down in Minneapolis, but its officers are still active in the city and state. At Fairview Health Services, one of the two largest health care networks in the Twin Cities, hospital administrators are resisting efforts by labor union leaders to establish clear protocols for ensuring that patients are protected from Immigration and Customs Enforcement (ICE) officers, and that caregivers are able to do their jobs and provide all patients with the care they need.

The fight in the Twin Cities over how hospitals respond to ICE comes as the country confronts a lawless agency that has grown so rapidly that it is now the world’s 13th-largest military force. The way hospitals choose to respond to ICE’s actions will determine whether or not the estimated 11 million undocumented people living in the U.S. continue to get medical care in the coming years.

On February 19, ICE agents arrested a Mexican immigrant named Adrian Sotelo Guzman in Minneapolis. Once he showed signs of extreme mental distress, they brought him to the emergency room at M Health Fairview Southdale Hospital in Edina, an inner suburb of Minneapolis and the closest hospital to the Whipple Federal Building, where ICE operations are based. While Sotelo Guzman was awaiting a hearing about the hospital’s recommendation that he be civilly committed, ICE agents returned on February 27, removed him from the ER, and sent him to Montgomery Processing Center in Texas, which has routinely failed to provide adequate mental health care to inmates. Fairview facilitated the transfer over the objection of its own health care providers. In recent legal filings, Sotelo Guzman’s lawyers allege that he was given powerful sedatives to facilitate his transfer, and his family has expressed concern about his well-being.

“Hospitals are treating ICE and Customs and Border Protection detainees the same as people who have been arrested.”

“For weeks ICE has been present in and around hospitals in the Twin Cities,” said Jill Lebrun, a registered nurse at M Health Fairview Riverside and treasurer of the Minnesota Nurses Association, at a February 20 press conference. The presence of federal immigration agents “undermines trust and interferes with people seeking care. Every patient deserves to feel safe in our hospitals regardless of their immigration status. When patients are detained, that means fear. People delay care, avoid hospitals, they suffer in silence. When trust erodes, patient safety erodes with it.”