This article is published in partnership with the Center for Media and Democracy.

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.

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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.”

The health care workers’ proposed solution: clear policies that differentiate between ICE officers and local or state law enforcement, express regulations clarifying that ICE detainees are under administrative detention, and limit out-of-state transfers (as much as possible). So far, Fairview has resisted these demands from unions and community groups.

Jamey Sharp, a medical student and organizer with the community group Unidos MN, told the Center for Media and Democracy (CMD) that hospitals need to have separate policies for ICE and local law enforcement—something that Fairview has resisted. “It’s the biggest problem we face,” he said—that hospitals are treating ICE and Customs and Border Protection (CBP) detainees the same as people who have been arrested. “Individuals who are in ICE custody are under administrative civil detention. [But if] someone … is in the custody of Minneapolis police or the Hennepin County sheriff, they’re in criminal custody. There are very defined laws about when someone is in criminal custody,” including that the state can (and in some situations is required to) shackle them. “None of these [laws] apply to [people in] ICE civil detention.”

On March 10, Democratic members of the Minnesota Senate introduced SF 4242, a bill that would limit ICE agents from accessing nonpublic areas of health care facilities without a judicial warrant, require hospitals to develop formal policies for immigration enforcement, and limit the amount of patient information that can be shared with immigration authorities.

Unlike its main competitor in the region, Allina Health, or the dominant player in health care in Minnesota, the Mayo Clinic, Fairview is a quasi-public nonprofit network. It operates the University of Minnesota’s hospitals under an affiliation agreement that was just renewed at the end of January, though the attorney general has the ability to review the terms. Both the dean of the University of Minnesota Medical Center (under the Fairview umbrella) and the university’s vice president of health sciences, or their designees, are allowed to sit as ex officio members of Fairview’s board of directors.

The region’s public hospital, Hennepin County Medical Center, has worked with community organizations to clearly delineate patients in ICE detention from those involved in criminal proceedings, receiving plaudits from unions and community groups like Unidos.

In certain cases where ICE agents bring a patient to the hospital for care, “rights are being infringed on not just by ICE, but by hospitals as well,” said Sharp. “The point is that these hospitals need to be ready and equipped [to uphold the] constitutional rights [of undocumented patients]. ICE [officers] can remain there as chaperones,” but hospitals should not facilitate transfers to unsafe detention centers, Sharp argued.

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“Our job first and foremost is the care and safety of our patients—all our patients,” said Kaitlin McLean, a medical resident at Fairview who helps lead the Committee of Interns and Residents union, at the February 20 press conference. “Unfortunately, as we all know after the last several weeks, our communities have been impacted in ways we’ve never imagined. Kids with infections waited until [the situation] was so severe it required an ICU stay. There are impacts on health that we may never be able to truly quantify for years to come.”

“Federal immigration officials have been in these hospitals,” McLean said. “It’s beyond important that we have guidelines and policies that protect our staff and our nurses,” as well as patients.

In a statement, a Fairview spokesperson told CMD that while they are “not able to discuss details of a specific case or internal clinical decision-making … Fairview’s hospitals and clinics provide care to anyone who needs it. We do not participate in civil immigration enforcement. Our policies are designed to protect patient privacy, support staff safety, and ensure that clinical teams determine when care is complete and when discharge is medically appropriate.”

The Fairview representative declined to address ICE specifically in the statement, nor did she respond to a request for comment about the organization’s position on SF 4242.

Fairview’s board also includes David Levy, who is the senior executive in charge of government contracting at Amazon Web Services (AWS). AWS has received $64 million in payments from ICE since President Trump took office, according to reporting by Forbes.

“Fairview claims its vision is to be the most human-centered health care system [in the state],” said Kirby Crow, a member of SEIU Healthcare Minnesota & Iowa at Fairview, at the press conference. “Fairview’s administration is not living up to that vision. ICE agents have covered up hospital security cameras in the ER, racially profiled workers, shackled patients, detained a worker, traumatized our patient population. For months we have carpooled with immigrant co-workers, joined neighborhood and school patrols, and administered mutual aid networks. Where was Fairview?”

Support for Adrian Sotelo Guzman is being collected via GoFundMe.

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Matthew Cunningham-Cook is a writer and researcher with expertise in health care, retirement policy, and capital markets. He has written for The Intercept, The Lever, The New York Times, The Nation, Al Jazeera, and In These Times.