Missed childhood vaccinations. Skipped blood sugar checks. Medications abandoned at the pharmacy.

These are among the healthcare disruptions providers have noticed since Immigration and Customs Enforcement operations began in Southern California earlier this month.

Across the region, once-busy parks, shops and businesses have emptied as undocumented residents and their families hole up at home in fear. As rumors of immigration arrests have swirled around clinics and hospitals, many patients are also opting to skip chronic-care management visits as well as routine childhood check-ups.

In response, local federally qualified health centers — institutions that receive federal funds and are required by law to provide primary care regardless of ability to pay — have been scrambling to organize virtual appointments, house calls and pharmacy deliveries to patients who no longer feel safe going out in public.

“We’re just seeing a very frightening and chaotic environment that’s making it extremely difficult to provide for the healthcare needs of our patients,” said Jim Mangia, president of St. John’s Community Health, which offers medical, dental and mental health care to more than 100,000 low-income patients annually in Southern California.

Prior to the raids, the system’s network of clinics logged about a 9% no-show rate, Mangia said. In recent weeks, more than 30% of patients have canceled or failed to show. In response, the organization has launched a program called Healthcare Without Fear to provide virtual and home visits to patients concerned about the prospect of arrest.

“When we call patients back who missed their appointment and didn’t call in, overwhelmingly, they’re telling us they’re not coming out because of ICE,” said Mangia, who estimates that 25% of the clinic’s patient population is undocumented. “People are missing some pretty substantial healthcare appointments.”

A recent survey of patient no-shows at nonprofit health clinics across Los Angeles County found no universal trends across the 118 members of the Community Clinic Assn. of L.A. County, President Louise McCarthy said. Some clinics have seen a jump in missed appointments, while others have observed no change. The data do not indicate how many patients opted to convert scheduled in-person visits to telehealth so they wouldn’t have to leave home, she noted.

Patients have also expressed concerns that any usage of health services could make them targets. Earlier this month, the Associated Press reported that the U.S. Department of Health and Human Services shared the personal data of Medicaid enrollees with the U.S. Department of Homeland Security, including their immigration status. No specific enforcement actions have been directly linked to the data.

“The level of uncertainty and anxiety that is happening now is beyond the pale,” McCarthy said, for patients and staff alike.

County-run L.A. General Medical Center issued a statement on Thursday refuting reports that federal authorities had carried out enforcement operations at the downtown trauma center. While no immigration-related arrests have been reported at county health facilities, “the mere threat of immigration enforcement near any medical facility undermines public trust and jeopardizes community health,” the department said in a statement.

Los Angeles County is among the providers working to extend in-home care options such as medication delivery and a nurse advice line for people reluctant to come in person.

“However, not all medical appointments or conditions can be addressed remotely,” a spokesperson said. “We urge anyone in need of care not to delay.”

Providers expressed concern that missing preventative care appointments could lead to emergencies that both threaten patients’ lives and further stress public resources. Preventative care “keeps our community at large healthy and benefits really everyone in Los Angeles,” said a staff member at a group of L.A. area clinics. He asked that his employer not be named for fear of drawing attention to their patient population.

Neglecting care now, he said, “is going to cost everybody more money in the long run.”

A patient with hypertension who skips blood pressure monitoring appointments now may be more likely to be brought into an emergency room with a heart attack in the future, said Dr. Bukola Olusanya, a medical director at St. John’s.

“If [people] can’t get their medications, they can’t do follow-ups. That means a chronic condition that has been managed and well-controlled is just going to deteriorate,” she said. “We will see patients going to the ER more than they should be, rather than coming to primary care.”

Providers are already seeing that shift. When a health team visited one diabetic patient recently at home, they found her blood sugar levels sky-high, Mangia said. She told the team she’d consumed nothing but tortillas and coffee in the previous five days rather than risk a trip to the grocery store.

At the heart of the new Vera C. Rubin Observatory in Chile is the world’s largest digital camera. About the size of a small car, it will create an unparalleled map of the night sky.

The observatory’s first public images of the sky are expected to be released on June 23. Here’s how its camera works.

When Times reporters visited the observatory on top of an 8,800-foot-high mountain in May, the telescope was undergoing calibration to measure minute differences in the sensitivity of the camera’s pixels. The camera is expected to have a life of more than 10 years.

A single Rubin image contains roughly as much data as all the words that The New York Times has published since 1851. The observatory will produce about 20 terabytes of data every night, which will be transferred and processed at facilities in California, France and Britain.

Specialized software will compare each new image with a template assembled from previous data, revealing changes in brightness or position in the sky. The observatory is expected to detect up to 10 million changes every night.

Some changes will be artificial. Simulations suggest that roughly one in 10 Rubin images will contain at least one bright streak or glint from the thousands of SpaceX Starlink and other satellites orbiting Earth.

Despite streaks, clouds, maintenance and other interruptions over the next decade, the Rubin Observatory is expected to catalog 20 billion galaxies and 17 billion stars across the Southern sky.

Official U.S. records dramatically underestimate mortality and life expectancy disparities for Native Americans, according to a new, groundbreaking study published in the Journal of the American Medical Association. The research, led by the Boston University School of Public Health, provides compelling evidence of a profound discrepancy between actual and officially reported statistics on the health outcomes of American Indian and Alaska Native (AI/AN) populations in the U.S.

The study, novel in its approach, tracks mortality outcomes over time among self-identified AI/AN individuals in a nationally representative cohort known as the Mortality Disparities in American Communities. The researchers linked data from the U.S. Census Bureau’s 2008 American Community Survey with official death certificates from the Centers for Disease Control and Prevention’s National Vital Statistics System from 2008 through 2019, and found that the life expectancy of AI/AN populations was 6.5 years lower than the national average. They then compared this to data from the CDC’s WONDER database, and found that their numbers were nearly three times greater than the gap reported by the CDC.

Indeed, the study found that the life expectancy for AI/AN individuals was just 72.7 years, comparable to that of developing countries.

The researchers also uncovered widespread racial misclassification. The study reports that some 41% of AI/AN deaths were incorrectly classified in the CDC WONDER database, predominantly misrecorded as “White.” These systemic misclassifications drastically skewed official statistics, presenting AI/AN mortality rates as only 5% higher than the national average. When they adjusted the data to account for those misclassifications, the researchers found that the actual rate was 42% higher than initially reported.

The issue of racial misclassification “is not new for us at all,” said Nanette Star, director of policy and planning at the California Consortium for Urban Indian Health. The recent tendency for journalists and politicians to use umbrella terms like “Indigenous” rather than the more precise “American Indian and Alaska Native” can obscure the unique needs, histories and political identities of AI/AN communities, Star noted, and contribute to their erasure in both data and public discourse. “That is the word we use — erasure — and it really does result in that invisibility in our health statistics,” she said.

Issues related to racial misclassification in public records persist across the entire life course for AI/AN individuals, from birth to early childhood interventions to chronic disease and death. Star noted that in California, especially in urban regions like Los Angeles, Native individuals are frequently misidentified as Latino or multiracial, which profoundly distorts public health data and masks the extent of health disparities. “It really does mask the true scale of premature mortality and health disparities among our communities,” Star said.

Further, said Star, the lack of accurate data exacerbates health disparities. “It really is a public health and justice issue,” she said. “If you don’t have those numbers to support the targeted response, you don’t get the funding for these interventions or even preventative measures.”

According to U.S. Census data, California is home to the largest AI/AN population in the United States. That means it has a unique opportunity to lead the nation in addressing these systemic issues. With numerous federally and state-recognized tribes, as well as substantial urban AI/AN populations, California can prioritize collaborative and accurate public health data collection and reporting.

Star noted that current distortions are not always malicious but often stem from a lack of training. She suggested that California implement targeted training programs for those charged with recording this data, including funeral directors, coroners, medical doctors and law enforcement agents; allocate dedicated resources to improve the accuracy of racial classification on vital records; and strengthen partnerships with tribal leaders.

The study authors suggest similar approaches, and there are numerous examples of successful cases of Indigenous-led health partnerships seen across Canada and the U.S. that have helped reduce health disparities among AI/AN communities that could be used as a template.

These efforts would not only help to move toward rectifying historical inaccuracies, but also ensure that AI/AN communities receive equitable health resources and policy attention.

“When AI/AN people are misclassified in life and in death, it distorts public health data and drives inequities even deeper,” said Star. “Accurate data isn’t just about numbers — it’s about honoring lives, holding systems accountable and making sure our communities are seen and served.”