But last week, I did.
For seven months, Gisela’s 2-year-old son, Anthony, had been getting fevers. With each one, his eye would swell. He was treated with eye drops, nasal sprays and antibiotics, but the swelling always returned.
Last week, his condition worsened. Anthony had had fevers for seven days, then his eye swelled shut and his nose began to bleed. He was admitted to a hospital in Texas’s Rio Grande Valley — just miles from the Mexican border — and treated with antibiotics. On the third day of his hospitalization, he wasn’t improving. Anthony’s doctor called San Antonio’s public hospital, where I work, to ask if our specialists could take him in.
As a hospital pediatrician, I help arrange medical transport for children from across South Texas. When I talk with worried caregivers who have really sick kids in tiny rural hospitals, I hear the relief in their voices when I offer to send our pediatric transport team.
Anthony was one of these cases. If infections around the eye are not treated correctly, they can spread behind the eyeball and even into the brain. I have cared for children who had to have their skulls cut open to relieve pressure from pus inside the brain; I have also seen children who lost their vision from these infections.
We hoped to prevent those devastating complications for Anthony. But getting him to San Antonio was not a simple matter of medical logistics.
The Rio Grande Valley where Gisela has lived for 12 years is home to much of Texas’s undocumented population, estimated in 2017 to be about 1.6 million. And in the Valley, the rules are different. While the Fourth Amendment means federal agents must usually have “probable cause” or a warrant to inspect vehicles, within 100 miles of any U.S. border, Customs and Border Protection (CBP) adheres to a lower standard: They may stop and search cars over a “reasonable suspicion” of a customs or immigration violation.
A series of permanent checkpoints stands along the highways between the 100-mile Rio Grande buffer zone and the rest of Texas. For this reason, the Valley has been called “a jail with a beach.” Undocumented Texans are trapped there, unable to pass deeper into the state for fear of being apprehended at a checkpoint.
This is why Gisela initially refused to have Anthony transported to our facility. An undocumented immigrant from Honduras, she told the doctors she was in the United States illegally and afraid of being apprehended at a checkpoint. We considered sending a helicopter to transport Anthony alone — weight restrictions generally prevent parents from joining their children — but Gisela did not want to be separated from her sick toddler. Finally, it was decided that she and Anthony would travel together in an ambulance.
To safeguard the health of immigrants and to prevent the spread of disease, medical ethicists generally advise that physicians’ offices and hospitals should be safe spaces, where undocumented persons can seek care without fear. Doctors have no legal obligation to report undocumented patients; in fact, doing so may constitute a violation of the Health Insurance Portability and Accountability Act.
None of this helped Gisela. At her hospital in the Valley, once she disclosed that she was undocumented, she was visited by the hospital’s social worker. From their conversation, Gisela understood that she had two options: talk to CBP officials there, in the hospital, or face them at the checkpoint. Gisela agreed to talk to CBP there. "[The social worker] just told me they would take some information,” Gisela recounted to me. “I didn’t know they would take me into custody.”
A colleague told me that the team in the Valley thought CBP would actually help the family, escorting the ambulance through the checkpoint specifically to prevent Gisela from being detained. But when the immigration official arrived at Anthony’s hospital room, the first thing she did was pull out a computer and take Gisela’s fingerprints.
Gisela had trusted her son’s doctors. Now agents were taking her into custody.
Historically, border agents have declined to pursue people involved in “humanitarian situations” — ambulances, for example, have been allowed to pass through the checkpoints without hindrance. But recent years have seen an erosion of that tolerance. In 2017, when Hurricane Harvey struck South Texas, the Border Patrol did not suspend the checkpoints, so undocumented people had to choose between deportation and natural disaster. That same year, 10-year-old Rosamaria Hernandez was pursued by CBP and ultimately detained after passing through a checkpoint via ambulance on her way to Corpus Christi for emergency surgery.
In Gisela and Anthony’s case, CBP agents escorted the ambulance all the way to San Antonio and followed the family inside our hospital. When I met them, a Border Patrol officer was stationed outside Anthony’s room. One morning, he barged into Anthony’s room without knocking or donning the gown and mask he was required to wear to prevent the spread of infection; for Gisela, this was as frightening as if a cop had appeared in her child’s bedroom at home.
In the hallway of the hospital, the officer issued Gisela orders to appear in immigration court for deportation. “A lawyer will just charge you money money money,” I heard him say, just before Gisela signed the deportation papers. Later, she asked me to read the papers to her, because she didn’t understand them. They were in English. One of the documents set Gisela’s court date — next Tuesday, Feb. 11.
Anthony, for his part, was a model patient. Like any 2-year-old, he cried and fought when the nurse put his eye drops in, but calmed in the arms of his mother. As he recovered, he began to giggle and play. He was discharged this past weekend. A friend drove Anthony and his mom back to the Valley, where Gisela is now trying to take care of her legal situation and get Anthony to his follow-up appointments.
While I am pleased that Anthony’s infection has improved, I worry about what will happen to him, a U.S. citizen, if his mother is sent back to Honduras. When Gisela said to me and my colleagues at the hospital, “I never should have come here,” we flinched. Though we have had the best of intentions, we feel implicated.
Border-state doctors and patients cannot rely on the individual moral orientation of Border Patrol officers to protect access to emergency care. As a physician, I have a responsibility to care for all patients regardless of their citizenship or affiliation. But my commitment alone cannot protect my patients. State and federal law must prohibit immigration screening and enforcement during medical transport through checkpoints and within clinics and hospitals.
The lives of children like Anthony depend on it.