Science
Migrants Are Skipping Medical Care, Fearing ICE, Doctors Say
A man lay on a New York City sidewalk with a gun shot wound, clutching his side.
Emily Borghard, a social worker who hands out supplies to the homeless through her nonprofit, found him and pulled out her phone, preparing to dial 911. But the man begged her not to make the call, she said.
“No, no, no,” he said, telling her in Spanish that he would be deported.
Ms. Borghard tried to explain that federal law required hospitals to treat him, regardless of his immigration status, but he was terrified.
“He said, ‘If I go to the emergency department, that will put me on their radar,’” she recalled in an interview recounting the incident.
Across the country, doctors, nurses and social workers are increasingly concerned that people with serious medical conditions, including injuries, chronic illnesses and high-risk pregnancies, are forgoing medical care out of fear of being apprehended by immigration officials. Since the Trump administration announced plans for mass deportations and rescinded a Biden-era policy that protected spaces like hospitals, medical clinics and churches from immigration enforcement, doctors said they have seen sharp increases in patient anxiety and appointment no-show rates.
If the trend continues, health care officials say, the list of consequences could be long: Infectious diseases circulating unnecessarily; worsening health care costs because of untreated chronic illnesses; and dangerous birth complications for women who wait too long to seek help, among others.
In a survey conducted by KFF, a health policy research organization, 31 percent of immigrants said that worries about immigration status — their own or that of a family member — was negatively affecting their health. About 20 percent of all immigrants surveyed said they were struggling with their eating and sleeping; 31 percent reported worsened stress and anxiety.
A White House spokesman did not respond to messages seeking comment. When the administration announced that it was ending protections at hospitals on Jan. 21, a statement from the Department of Homeland Security said the new policy was intended “to enforce our immigration laws and catch criminal aliens.”
Research has shown that immigration crackdowns are linked with poorer birth outcomes and mental health status, lapses in care, and fewer people accessing the types of public programs that reduce illness and poverty overall.
“We’re really creating not just very serious health risks, but economic risks in the long run for our country,” said Julie Linton, a pediatrician and member of the committee on federal government affairs for the American Academy of Pediatrics. “These policies are creating very real fear and uncertainty for people and have a tremendous impact on their ability to function on a day-to-day level.”
Chronic Conditions
Many immigrant communities suffer from high rates of chronic conditions such as high blood pressure and diabetes, which, if left untreated, can lead to heart attack, stroke and other grave complications.
That is why doctors worry about patients like Maria, a 47-year-old woman with pre-diabetes, who has been going to the same primary care clinic ever since she arrived in the United States from El Salvador 20 years ago. Even during the first Trump administration’s crackdown on immigration, she continued to seek medical care. But when the protections around hospitals and clinics were rescinded earlier this year, Maria canceled her appointment to have her blood sugar checked, a routine and crucial element of diabetes prevention in patients like her.
“We’re very scared of being in the clinic and having ICE arrive while waiting to be called,” she said in Spanish, referring to U.S. Immigration and Customs Enforcement.
Maria, who asked that her last name not be published, said that she is in a state of “constant anguish.” She said she avoids leaving the house and is working on a plan for the care of her children, who are American citizens, in case she and her husband are deported.
One of their daughters, who is 15, is being treated for fatty liver disease and the other, 11, needs therapy for a developmental condition. Their older daughter has another doctor’s appointment in June. Maria and her husband don’t want to interrupt her care, but they are worried about taking her there themselves. “It’s very complicated,” Maria said. “I can put myself at risk for my children. But if it’s for my own health, I prefer to let it go.”
The consequences of abandoning regular medical care can turn serious quickly, however. Jim Mangia, president of St. John’s Community Health Network in Los Angeles described one patient with diabetes who stopped showing up for a weekly diabetes education class. When a clinic staff member called the woman, they discovered she was afraid to even go to the grocery store, and had been subsisting for days on tortillas and coffee, he said.
“Thank God we reached her and she came in,” said Mr. Mangia, whose network serves an estimated 25,000 undocumented patients across more than 20 locations. Tests at the clinic showed that her blood sugar had become dangerously high.
“That’s what we’re going to see more and more of,” Mr. Mangia said. “It kind of breaks my heart to talk about it.”
Acute Care
For doctors working in urgent care settings, a drop-off in immigrants has become apparent through some unusual metrics. For example, Dr. Amy Zeidan, an emergency room physician in Atlanta, said that requests for Spanish-language interpretation in her hospital’s emergency department had fallen more than 60 percent from January to February.
Theresa Cheng, an emergency room physician at Zuckerberg San Francisco General Hospital and Trauma Center, said one of her residents had seen an immigrant patient who had suffered multiple facial fractures from an assault, but had not sought care for more than two weeks. “There is tremendous fear,” Dr. Cheng said.
In late January, Dr. Cheng said, she saw a patient who arrived with severely untreated diabetes. The patient, an undocumented woman, said she had waited to receive help because she was scared. She died that day.
Dr. Carolina Miranda, a family physician in the Bronx, spoke of a patient who had been granted asylum but, fearful of ICE, had failed to show up for a doctor’s appointment about a possible brain tumor.
Similar delays or cancellations are arising among pregnant women and new mothers, according to obstetrician-gynecologists around the country. Dr. Caitlin Bernard, an obstetrician in Indiana, said a patient had skipped her postpartum visit, explaining that she would no longer be leaving her house. On an obstetrics floor in a San Diego hospital, multiple staff members said they had seen an overnight drop-off following the inauguration in the number of immigrant women coming in with acute issues during their pregnancies.
“Obviously those women still exist,” said one doctor, who asked not to be identified because her employer forbade her from speaking publicly on the matter. “I fear it’s going to increase maternal mortality over time. ”
Children’s Health
Many of the children of immigrant parents who have skipped appointments or left medications unfilled are American citizens. But in mixed-status families, parents who are at risk of deportation are often unwilling to take the risk of going to the clinic or pharmacy.
A pediatrician at a health center that cares for underserved populations on the central coast of California reported a 30 percent increase in no-shows for pediatric appointments. Many of those who do bring their children, and are referred elsewhere for specialty care, such as speech therapy, or an autism evaluation, refuse, saying they are too frightened, said the pediatrician, who asked to be unidentified because he wasn’t authorized to speak publicly.
Dr. Tania Caballero, a pediatrician at Johns Hopkins who sees patients at a health center for underserved groups called Baltimore Medical System, said she had encountered parents who had not wanted to go with their babies to the emergency room out of fear, and parents of children with chronic conditions like cerebral palsy, asthma, and Type 1 diabetes who had told her they have stopped getting vital care.
“I tell patients, ‘I can’t control what happens outside of my space, and I can’t control if somebody comes into my space, But you know me. I have the tools, and I want to help you navigate this journey and do it together,’” she said.
Some parents of children in other dire situations — such as those receiving cancer treatment — are hoping that their child’s condition might actually protect them. Some have asked pediatricians for letters explaining their child’s medical requirements, in hopes that immigration officials who detain them might be convinced that the child needs to stay in the United States to survive.
Dr. Lisa Gwynn, a pediatrician in South Florida who serves families from across the Caribbean and South America, said that her plummeting patient attendance rate is particularly worrisome because patients are missing out on childhood vaccines necessary for preventing diseases like measles, pneumonia and whooping cough.
Dr. Gwynn also worries that without coming to see her, children who have experienced severe trauma before coming to the United States aren’t being connected to social workers or psychologists who can help.
“Imagine your children living in a home where everyone’s scared, and they’ve come to this country to not feel scared anymore,” she said. “We know that stress does not fare well for health. Period. Kids don’t perform as well in school, they have mental health issues, depression, anxiety. ”
A Dilemma for Hospitals
Some medical facilities have said they will comply with immigration officials. NYU Langone, in New York City, sent a memo to employees warning them not to try to protect illegal migrants. But many other health centers and organizations are finding ways to take a stand, telling staff to display “Know Your Rights” information on the walls and to never record their immigration status in a patient’s medical records. ”
Last week, the New England Journal of Medicine published an article by two doctors and a lawyer detailing how physicians can continue to provide health care and lawfully push back in the face of some ICE requests.
The St. John’s clinic network in Los Angeles recently launched an ambitious home visitation program in which a doctor, nurse and medical assistant visit patients’ where they live to perform exams and deliver medications. They aim to inform all 25,000 of their undocumented patients of this option.
In the New York area, a hospital association suggested designating a “hospital liaison” who can be paged to quickly usher an agent into a private office, and then ask to see a signed warrant, which would then be reviewed by in-house counsel.
At the emergency room of University Hospital, a safety net facility in Newark, staff members hand out cards, in Spanish and other languages, reminding patients of their rights. “You have the right to refuse consent for immigration or the police to search yourself, your car or your home,” the cards state.
But even there, the fear is palpable. Annalee M. Baker, an emergency physician, said she had seen a young woman who said her partner had beaten her until she was unconscious. Covered in welts and bruises, she had waited hours to come in. The reason given: she was terrified that her partner would be deported.
Dr. Baker also treated a minor who had been stabbed; she had needed his parents’ consent to treat him, but the boy had been skittish about providing any details about them, out of fear they might be caught in the immigration dragnet.
Still, it is the people who never come in at all that haunt Dr. Baker the most.
“The tragic message to these people is: Be a shadow and hope that you do not die.”
Sarah Kliffcontributed reporting.
Science
As mosquitoes go year-round in L.A., a promising fix hits a snag
Residents were supposed to get a respite from the ankle-nipping mosquitoes that fueled a recent surge in dengue fever in Los Angeles County.
Typically, the invasive mosquitoes — called Aedes aegypti — essentially disappear from winter until early May in the region.
Instead, complaints to local agencies tasked with controlling the pests spiked recently.
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“We have not seen them go away altogether like they have in previous years,” said Susanne Kluh, general manager for the Greater Los Angeles County Vector Control District.
Their unusual presence adds to the urgency of work going on in a 40-foot shipping container tucked away in Pacoima. It’s about to transform into a bustling nursery for tens of thousands of mosquitoes.
This May, the district is set for the third year in a row to release legions of sterilized male mosquitoes — which don’t bite — into parts of Sunland-Tujunga.
The last two years were promising, with the female population in two treated neighborhoods plunging by an average of more than 80%.
Yet business owners have signaled they’re not willing to pay to expand it.
That’s thrown uncertainty into officials’ goal of eventually bringing the approach to their whole service area, spanning 36 cities and unincorporated communities.
Steve Vetrone, assistant general manager at the Greater L.A. district.
(Ronaldo Bolanos / Los Angeles Times)
“Unfortunately, that’s going to be a rather expensive endeavor,” said Steve Vetrone, an assistant general manager for the district. “I can tell you right now that’s not something that we can do with our current operating budget.”
A need, an ask and a disappointing answer
Aedes aegypti are a new-ish local fixture. Native to Africa, the black-and-white striped mosquitoes were first detected in California in 2013 and landed in L.A. County the following year.
“Despite our best efforts, they’ve been able to just outpace us, and they’re now in every city and community within our district,” and all of Southern California, Vetrone said. In fact, the low-flying, day-biting mosquitoes are present in nearly half of California’s counties, including Shasta in the far north.
Desperate to find a solution, many are trying the so-called sterile insect technique — including vector control districts serving Orange and San Bernardino counties, as well as the San Gabriel Valley — and “we kind of all hope that this is going to be our silver bullet,” Kluh said.
The idea is fairly simple: unleash sterile males so that they far outnumber wild ones — say, 10 to 1 or even 100 to 1. The goal is for the altered males to mate with females, producing eggs that don’t hatch.
Kluh’s district uses X-rays to sterilize males but there are other methods, such as using genetically modified insects or ones infected with bacteria.
Female mosquitoes are fed different types of blood — pig and cow — to see which leads to the most eggs.
(Ronaldo Bolanos / Los Angeles Times)
The technique, while promising, requires time and money.
In California, property owners foot the bill for local mosquito (and other pest) control, with some paying an annual fee called a benefit assessment.
Levying a new fee requires approval from home, apartment and business owners, in accordance with Proposition 218.
To unleash sterile male mosquitoes in a broader swath of the Greater L.A. district, officials are seeking up to $20 a year per single family home. That would be on top of $18.97 that homeowners now pay for the agency’s services.
Last April, the district sent out 50,000 sample ballots to property owners, asking if they’d support the increase.
Only 47% of those returned were in favor.
“Data showed that single family homeowners were pretty supportive, but fewer business owners with larger parcels and potentially higher dues did not see the benefit in the additional expense,” Kluh said in an email.
Business owners might not live in the area, but their vote — if their property spans several acres — is weighted more heavily.
Times readers, commenting on a story from last year about the proposal, responded favorably.
“I hate mosquitos because they love me so much,” one reader said. “I would happily spend $20 to reduce their populations! I probably spend more [than] that on repellent.”
Officials haven’t given up, and plan to send out another round of sample ballots next year.
Kluh already has talking points for businesses in her back pocket: Restaurant owners should have an interest in making outdoor dining more pleasant, while apartment owners could lose revenue if their renters are sickened by an outbreak of Zika, chikungunya or yellow fever — all diseases transmitted by Aedes aegypti, she said.
Making mosquitoes that can’t reproduce
On a recent tour of the Pacoima insectary, Nicolas Tremblay, a senior vector ecologist with the district, whipped out a small container filled with a handful of what looked like vitamins.
But the clear pill cases were filled with about 6,500 mosquito eggs and bovine liver powder.
Nicolas Tremblay, senior vector ecologist, tapes trays to indicate pill capsules filled with mosquito eggs were placed in water.
(Ronaldo Bolanos / Los Angeles Times)
The pills are dropped into trays of water, where the eggs hatch and the larvae feed on the powder. It takes about nine days to go from egg to buzzing adult.
The males are then chauffeured to Garden Grove, where they’re zapped with X-rays. Then they’re driven back and set free the next day.
“It’s crazier around August, September, is when we’ll probably reach our peak production” of up to 72,000 mosquitoes a week, he said. “All these [trays] would be full of water and mosquitoes.”
In 2024, the district launched its pilot, releasing nearly 600,000 sterilized males in two Sunland-Tujunga neighborhoods over about five months.
The population of Aedes aegypti females dropped by an average of 82% compared with a control area.
The stakes became clear that year, when California reported 18 locally acquired dengue cases — a sharp rise from the first-ever cases confirmed the year before.
Last year, the pilot saw similar success, though there was also a natural drop in activity districtwide.
On the recent visit to the insectary, several hundred mosquitoes flew around in white mesh cages, serving as participants in a study to see which blood they prefer — pig or cow.
“We haven’t completed the trials yet, but it seems like they didn’t care,” he said.
One thing scientists already know: Aedes aegypti love biting people.
A highly adaptive foe
The invasive mosquitoes can lay their eggs in tiny amounts of water. A bottle cap or crease in a potato chip bag is fair game.
What’s more, mosquitoes in the Greater L.A. district are resistant to a lot of pesticides.
Now, there might be a new concern. Typically, the invasive mosquitoes go into a type of hibernation every year.
Kluh said it appeared that they may have mutated in a way that allows them to stay active through the winter.
A warming climate has already expanded their season and allowed them to move into formerly inhospitable regions.
Releasing sterilized males involves no pesticides, and also leverages the insect’s biology: Males in lust are adept at finding females.
Many residents are thrilled by the promising tool, but others bristle at the idea of manipulating nature.
“There’s folks that are in favor and then there are folks that are just absolutely opposed because it’s like, ‘You’re playing God,’” Vetrone said.
Science
Record Heat Meets a Major Snow Drought Across the West
At this point in a typical year, as the seasons officially turn from winter to spring, snowpack would still be accumulating across the Mountain West.
But this winter wasn’t typical, even before a heat wave this past week. It was the warmest on record for six Western states. Snow cover is the lowest level on record for the Colorado River Basin, and across much of the rest of the West, there are record or near-record low amounts of snow.
That alone would create a challenging year for water managers, who rely on slow and steady snowmelt to feed streams, rivers and reservoirs and meet spring and summer demand for irrigation and drinking water. While rainfall runs off quickly and can more readily evaporate from soil, snowpack serves as a valuable and lasting source of moisture and accounts for a majority of water supplies across the region, as much as 80 percent in some areas.
Current snowpack compared to historical averages
The intense heat wave threatens to make water management all the more challenging.
Much of the thin snowpack was already “ready to melt” before the heat set in, said Jon Meyer, assistant state climatologist at the Utah Climate Center. “This is the nail in the coffin.”
It’s unusual to see the whole West like this, said Leanne Lestak, an associate senior scientist at the University of Colorado Boulder who specializes in mapping snow and how much water it holds.
In early March, Ms. Lestak and her team found that vast majority of the Western United States had less than two-thirds of the amount of snow typical for this time of year, with few exceptions. In Arizona and parts of Nevada, New Mexico and Oregon, snowpack was less than a quarter of what it would usually be.
“The situation is pretty dire,” Dr. Meyer said.
The heat wave is also increasing the already-elevated fire risk across some drought-stricken areas. In Nebraska, drought set the stage for the largest wildfire in state history, which broke out last week and has not yet been contained.
The conditions that led to this year’s low snowpack are unusual, too. Snow droughts often develop from dry weather patterns that starve the West of any significant precipitation during the winter, said Dan McEvoy, a climatologist at the Desert Research Institute and Western Regional Climate Center.
But in many places, it wasn’t necessarily a dry year, he said. Instead, temperatures have been so warm that precipitation has fallen as rain, rather than snow, even at higher elevations.
Many of the mountaintops could still see some more snowfall. But as Cody Moser, a hydrologist with the Colorado Basin River Forecast Center in Salt Lake City, looks ahead to predicting how the spring will go, he doesn’t foresee any significant change in weather patterns. Now he’s expecting peak snowmelt flows to occur earlier than ever recorded in many locations, he said this week.
“I think it’s highly likely we’ve seen peak snowpack,” Mr. Moser said.
Snowpack feeding the Colorado River reaches historic lows
Even after a winter that was the warmest on record for Arizona, New Mexico, Colorado, Utah, Wyoming and Oregon, the heat that set in across much of the West this past week was extreme. Meteorologists said they were expecting to set record highs for the month of March in many locations, and the earliest arrivals of 100-degree temperatures in records that go back more than a century.
Across the Colorado River Basin, even at elevations as high as 10,000 feet, temperatures were forecast to surge into the 50s and 60s Fahrenheit on Friday and Saturday, Mr. Moser said, some 15 to 20 degrees warmer than average.
Relatively light winds and dry air over the region could limit snowmelt to some degree, he said, but the warmth and sunshine may prevent some moisture from ever reaching stream beds, said John Fleck, a water policy expert at the University of New Mexico.
“A lot of it is going to evaporate off before it even has a chance to hit the stream,” Mr. Fleck said.
This heat wave is so extreme that it would only be expected to occur once about every 500 years in the current climate, according to World Weather Attribution, a group of scientists who study links between extreme weather events and climate change.
“These temperatures are completely off the scale for March, and our data shows that they would be virtually impossible in a world without human-caused climate change,” said Ben Clarke, a research associate in extreme weather and climate change at Imperial College London.
In places like the Colorado Front Range, home to the majority of that state’s population, snowpack serves as the largest source of water. For the utility Denver Water, snowpack usually contains significantly more water than its largest surface reservoir, said Taylor Winchell, the agency’s climate adaptation program lead.
Denver Water has enough supply to handle a low-water year, but the snowpack conditions are creating “very high levels of concern,” Mr. Winchell said. The Denver Water Board is poised to officially declare Stage One drought restrictions, asking residents to significantly reduce their outdoor watering. If the snow drought were to repeat for multiple years, the problem could compound and worsen, he said.
The snow drought occurs at a critical time for the larger Colorado River Basin. An agreement among the basin’s seven states over how to divide its water expired at the end of last year, and negotiations to develop a new water plan fell apart last month. (The states are also obligated to share a small portion of the water with Mexico.)
The snow drought is complicating that work. Snowpack from the river’s Upper Basin, across mountains of Colorado, Utah, New Mexico and Wyoming, accounts for a majority of the river’s natural flow each year. Declining spring precipitation and rising temperatures have caused the Colorado’s flow to decrease by nearly 20 percent over the past quarter century.
Recent forecasts estimated that inflows to Lake Powell, a key reservoir that straddles the Utah-Arizona border, will be the third-smallest on record. The lake’s surface could drop to a critical level for hydroelectric power production by the end of this year, affecting a power grid that serves seven states.
Officials at the Bureau of Reclamation, the federal agency that oversees the Colorado River and its reservoirs, declined to be interviewed but said in a statement they were monitoring hydrologic conditions to guide decisions about how to manage the Colorado River system.
Mr. Fleck said a crisis without precedent could be brewing. While a drought that hit the basin in 2002 was worse, it was relatively more manageable than what the West now faces: “We’re having one of the worst years in many decades, but with no cushion of reservoir storage to fall back on to bail us out.”
Science
New report on L.A. post-fire beach contamination finds something unexpected: good news
Researchers investigating the long-term effects of the 2025 firestorms on L.A.’s beaches have found that rarest of things: good news.
In the year following the Palisades and Eaton fires, levels of harmful metals like lead in coastal sand and seawater have remained far below California’s limits for safe drinking water and the U.S. Environmental Protection Agency’s safety thresholds for aquatic life.
“We’re not seeing any evidence for harm in the ecosystem or harm for human health,” said Noelle Held, a University of Southern California marine biogeochemist and principal investigator for the CLEAN Waters project, which is measuring post-fire water quality.
The Palisades and Eaton fires burned more than 40,000 acres and destroyed at least 12,000 buildings, blanketing the ocean in ash for up to 100 miles offshore. Heavy rains a few weeks later washed the charred remnants of plastics, batteries, cars, chemicals and other potentially toxic material into the sea and up onto beaches via the region’s massive network of storm drains and concrete-lined rivers.
Initial testing by the nonprofit environmental group Heal the Bay in the weeks after the fires documented a spike in lead, mercury and other heavy metals in coastal waters. Concentrations of beryllium, copper, chromium, nickel and lead in particular were significantly above established safety thresholds for marine life, prompting fears for the long-term health of fish, marine mammals and the marine food chain.
For their most recent study, Held’s team analyzed seawater samples collected along multiple locations on five different dates between Feb. 10 and Oct. 17 in 2025, along with sand collected in August.
Seawater lead concentrations were highest in the month after the fire and in October, when the season’s first major rain had just washed months’ worth of urban pollution into the ocean.
Even at their peak, lead levels barely surpassed 1 microgram per liter — well below the U.S. Environmental Protection Agency’s aquatic life safety threshold of 8.1 micrograms per liter.
While levels of iron, manganese and cobalt were higher in sampling locations near the Palisades burn scar than they were in other areas, even there they remain well below concentrations that could pose harm to human or marine life.
For beach sand collected in August, lead levels never topped 14 parts per million at any location, significantly below both the current California residential soil standard of 80 parts per million and the stricter 55 parts per million standard proposed by environmental health researchers.
“This isn’t something we would flag if we were testing your soil in your yard,” Held said.
The recent findings are consistent with water quality tests the State Water Resources Control Board conducted earlier in 2025. A board spokesperson said those found both higher relative concentrations of metals closest to the burn scars and no overall evidence that post-fire pollution poses an ongoing threat to human health.
Yet the need for continued testing remains. Officials struggled to answer questions about post-fire beach safety in part because of a lack of historical data on pollution levels, a pitfall researchers would like to forestall before another disaster arrives.
Future rainstorms could also continue to wash metals into Will Rogers Beach and the Rustic Creek outfall, both of which are near the Palisades burn scar, CLEAN Waters warned.
“Post-fire impacts can change over time, depending on rainfalls, runoffs and sediment movements,” said Eugenia Ermacora, manager of the nonprofit Surfrider Foundation’s L.A. chapter, which has partnered with Held’s team to collect samples. “It’s not just about the fires, but it’s about urbanization and how much our city needs to continue the work of doing testing in the water.”
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