Katie Russell 00:00:00 Again, employers have to walk a very careful line here. You know, doctors, staff, everyone at the practices need to know that over cooperation such as volunteering information or waiving rights, even inadvertently, that can violate privacy laws. Employer rights. It's a big quagmire.

Austin Luttrell 00:00:29 Welcome to Off the Chart, A Business of Medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the assistant editor of Medical Economics, and I'd like to thank you for joining us today. What would you do if I showed up at your practice? Would you know how to respond, what your rights are, or how to protect your staff and patients? In this episode, Physicians Practice editor Keith Reynolds speaks with Katie Russell, a partner at Brown Immigration Law in Cleveland, Ohio. Russell works with medical practices, hospitals and employers to help them navigate the complex intersection of immigration law and health care employment. She explains what physicians and practice managers should do if Ice arrives at their workplace, from identifying valid warrants to safeguarding patient information under HIPAA.

Austin Luttrell 00:01:12 Russell also shares how to prepare before a visit happens, including setting clear policies, auditing I-9 forms and training staff to stay calm and compliant. Katie, thank you for joining us. And now let's get into the episode.

Keith Reynolds 00:01:29 hey there folks. today we are talking to Katie P. Russell, partner at Brown Immigration Law in Cleveland, Ohio. How are you doing, Katie?

Katie Russell 00:01:36 I'm doing great. Keith. How are you?

Keith Reynolds 00:01:38 I can't complain too much. so I don't want to take up too much of your time, so let's just get into it.

Katie Russell 00:01:43 Perfect.

Keith Reynolds 00:01:44 If Immigration and Customs Enforcement or Ice agents show up at your medical practice, what should the first words or actions be from the physician or the front desk staff?

Katie Russell 00:01:56 So this is a great question, and what I always tell my clients, whether they're individuals, corporate clients, medical practices, the most important thing to do is to have a plan in place. if officers, law enforcement, Ice, whoever does decide to pay your office a visit, it's usually something that is unannounced.

Katie Russell 00:02:17 So you want to make sure that you're prepared and that element of surprise doesn't throw you or your staff off in terms of how you respond. So as an initial thing, I always say that every medical practice should designate a specific staff member, like an administrator or a member of the HR team, as the point of contact for any type of law enforcement interaction. And that's including immigration officials. this person ideally would be trained to review and verify any warrants presented or paperwork, communicate with the Ice agents professionally and effectively, document the encounter and make sure that there are follow up steps, such as communicating with legal counsel or an immigration attorney about what transpired during that visit. Additionally, going along with the plan theme, any practice should also have like a written protocol or instructions for folks in place just outlining how staff should respond. Again, having a plan is really going to help make you look organized. Have someone that's the go to. You can have a designated staff member and then even a secondary in the event that that person is not available.

Katie Russell 00:03:29 But the first response again just should be be calm, respectful and informed. if the designated person in the office is not the first person to have that interaction, it's perfectly fine for them to say, you know what? I'm not authorized to speak with law enforcement. Please give me a couple of minutes while I get our compliance officer or legal counsel, and then get that communication directed to the right person.

Keith Reynolds 00:03:54 Alrighty. So you mentioned warrants. So what's the difference between an administrative warrant and a judicial warrant? And why does it matter?

Katie Russell 00:04:02 It's so important and it's often very confusing. You know remember if agents, law enforcement, Ice are showing up to a practice or an office, it's going to throw people off. It's going to be really disorienting or it can be. So a couple of very important pointers about the difference between these two types of warrants is that an administrative warrant, like a form that Ice would have an issue that does not itself authorize entry into private spaces. that's going to be something that they would need to present to you whatever documentation is presented by the Ice officer.

Katie Russell 00:04:39 You should take a very careful note to look and see. Is this a form that starts with I and some numbers after it? Or does it have CBP or Ice or something designating the US Department of Homeland Security. If that's the case, it's likely an administrative warrant, whereas a judicial warrant is signed by a judge. And that is going to have some more specificity as to what that warrant enables the agents to do. It also needs to have the signature of the judge and the court heading on there. So with the administrative warrants does not have judicial authority. So it's not enforceable for entering into a private area. Now in this with the warrant stuff, it can be difficult because they do look somewhat similar and the appearance of these warrants can vary a bit. So that's why again, having some training in advance. And that's a service that our firm also provides, or any immigration attorney can provide to a practice to maybe provide some examples of what these warrants can look like, and to have someone that they're available to go escalate that communication to and check in with so they can take a look at it so they're not inadvertently waiving rights or violating someone else's rights by just saying, okay, I go right on in.

Katie Russell 00:05:59 You do have to make sure that the gatekeeping function of those warrants is safeguarded.

Multiple Speakers 00:06:08 Say, Keith, that's all well and good, but what if someone is looking for more clinical information?

Keith Reynolds 00:06:13 Oh, then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again that's patient care. Online com.

Multiple Speakers 00:06:27 All right so.

Keith Reynolds 00:06:28 Speaking of Ice just trying to get in. let's talk about if they're coming after your patients. So, what what about HIPAA? does this provide any sort of, protection, you know, can can agents just get in and legally access patient records or treatment areas, without patient consent or a court order?

Katie Russell 00:06:47 No. Of course. So HIPAA is still something that applies. It's protecting all patient health information regardless of their immigration status. Now, agents cannot access medical records or treatment areas if they only have an administrative warrant. So they would need to have either a valid judicial warrant, the patient's consent which is not recommended, or some other type of subpoena or court order that complies with HIPAA privacy rules and is very clear and explicit about exactly what it authorized them to to take.

Multiple Speakers 00:07:22 All right.

Keith Reynolds 00:07:23 So say they're looking for an employee or a doctor. say they've got visa issues. What is the employer's responsibility and what's the liability if they cooperate a little too much or too little?

Katie Russell 00:07:38 So there's a lot there. And again, this is such a tricky area, especially nowadays. Folks want to follow the rules, but they also want to protect the people that they're employing, that they're working with, or that they're treating. one important thing in terms of a medical practice in general is that once an employee is hired, there are required documents and paperwork that's going to need to be completed with, you know, their their background information and their ability to lawfully work in the United States. that's the form I-9. Every employer in the United States must complete one for every employee. And that form is designed to ensure that whichever individual you're hiring has the ability to work lawfully in the United States. So one initial thing that we recommend is regularly doing I-9 audits. So, you know, you'd have an HR that maintains all of those records, fills them out.

Katie Russell 00:08:35 But sometimes it can be a confusing form, or the onboarding process can be a little bit hectic. So it is important to make sure that all of that documentation Is together like in one binder. it's all in one area that's accessible. That way you can flag any issues, either with the form itself or if someone's a non-citizen of the United States making sure they have the proper documentation to work. I would say that's the first line of defense in terms of making sure that you're protecting your employees. But then again, if you have Ice showing up and saying, hey, we want to, you know, see this employee or look at this, you know, talk to this individual about their status. Again, employers have to walk a very careful line here. they're not required to disclose any employee information without a valid legal request. obviously the consent of that person would be required as well if there isn't some type of legal document granting that authority. So, you know, doctors, staff, everyone of the practices need to know that over cooperation such as volunteering information or waiving rights, even inadvertently, that can violate privacy laws.

Katie Russell 00:09:45 Employee rights. It's a big quagmire, so you just don't want to have yourself in a situation that you could have something get you in trouble by trying to be over cooperative. additionally, having, you know, that designated person on the staff who can help kind of field any of these questions are coming in. Ideally, you're going to have something in writing in advance. Immigration attorneys, employment attorneys often can prepare a document for you, so you don't have to go through any of the guesswork. but again, employers just need to be very careful about making any immigration related disclosures without getting that employee's consent and consulting an attorney or various types of attorneys to make sure it doesn't cause any issues.

Keith Reynolds 00:10:28 Speaking of attorneys, you know, at what point should the practice call their attorney? And, you know, what should that, you know, lawyers role be during or after, you know, of an Ice interaction.

Katie Russell 00:10:42 And this is a very common question that we've gotten, especially this year. There have been so many changes, a lot of people that have never really had to think about what to do in the event of ice communication or folks coming in and checking status.

Katie Russell 00:10:55 You know, it's a really scary area. you know, and what I always say is that just being prepared, having a plan in place, just to use have it as a back pocket thing, just in case you need to have that. But, you know, I as an immigration attorney, I've helped a lot of individuals and companies with this exact type of situation. So what our role is generally is that we would meet with, you know, the head doctor or the practitioner going over. All right, let's make sure that you've got everything put together. Do you have all of the I-9 paperwork properly prepared, organized in the event that ice shows up for a different type of inspection and wants to see you produce all the I-9 and supporting documents? Those types of visits can happen at any time. so it's one it's good to make sure that you have all of those things in place that administrators and HR, when they're going through the onboarding process, that they are educated and prepared and organized to make sure that those initial things are taken care of.

Katie Russell 00:11:54 That way, you won't have a surprise later on if you have Ice showing up saying, actually, this person was not authorized to work in the United States. So you just want to make sure you one you get all that stuff done. two we do very specifically tailored staff trainings depending on the type of practice and even the layout of the physical office. There are areas that are public spaces that law enforcement can visit and and access just by walking in the front door. But there are also places like in the back of the office or in private areas that agents cannot visit unless they have a warrant or they receive authorization from the staff. So sometimes, even if we have an on site training, we can help say all right. This is going to be the the no go area. This is going to be where these folks can go. Again, it's just about getting educated. then in the event of an Ice visit, I've gotten plenty of these calls this year where they say, hey, Katie, we've got some officers here.

Katie Russell 00:12:54 When can you come down? And I will get up, leave my office. I've responded to these types of investigations on site. again, it's just about being professional, clearly communicating, asking to see any documentation. They don't have that documentation. Hearing that a lawyer is coming by usually is enough to have them go and get whatever documentation they do need. But it's all about preparation and education.

Multiple Speakers 00:13:28 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60s, we deliver proven real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before launch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow hack and employee engagement win, or a lesson learned the hard way. I want to feature it. Shoot me an email at Kay reynolds@lifesciences.com with your topic, a quick outline, or even a smartphone clip.

Multiple Speakers 00:14:04 We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching and I'll see you in the next part. Two Management Minute.

Multiple Speakers 00:14:19 All right.

Keith Reynolds 00:14:20 So once Ice does leave, what steps should the practice take to document what occurred, protect its reputation and manage staff for patient anxiety.

Katie Russell 00:14:30 So yeah. So it can be very jarring after one of these visits. It can be a You shake up. You know, a lot of times. Again, it's the element of surprise that happens often with these encounters. So documentation is always the best thing to do. You know, even during the visit itself, asking to see any documentation, you know, looking at the the individual's identification or their badge, noting their name, noting the time of the visit, really recording as much as you can, especially if this is a visit that an attorney is not present. making sure you have all that information down. that's also going to be helpful for legal counsel to know.

Katie Russell 00:15:10 All right. Who came here? Who are they asking for? What were they asking about? What type of documentation or warrants or request did they provide? Because you should also get a photograph or a copy of those documents, because that's going to be very key to protecting the practice, making sure that you've done everything appropriately and you can take the appropriate follow ups.

Multiple Speakers 00:15:32 All righty. Alrighty. so for practices.

Keith Reynolds 00:15:35 That are employing international, medical graduates and visa sponsored, doctors, you know, what measures can they take or audits? can sort of reduce the likelihood of I shown up in the first place.

Katie Russell 00:15:52 Yeah. And it's, you know, it's often, you know, not a very salacious answer, but it's all about preparation, making sure that you are organized. If you've got folks that are working at your practice and enriching your business and practice with their experience, making sure that one you have a good handle on the type of visa that they have, or have someone on staff that can understand.

Katie Russell 00:16:16 All right, what are the ins and outs that this visa allows them to do? there are many different types of work visas in the United States. Anyone that holds a visa certainly would have had someone assisting them with the process. And immigration attorney that may or may not be with the medical practice itself. So just having a good understanding one of their, you know, the the visa information that they have, what job that allows them to do and very important information about expiration and renewal. as attorneys, even if we submit a petition and it's approved and we're so happy, the first thing we do after an approval is we go into our system and go, all right, it expires on this date. How far in advance do we need to initiate the conversation about renewing it or extending it, and just making sure that you're very mindful of those dates? if an individual is someone that you brought on your practice and they're doing great and they have a nonimmigrant or a temporary work visa, you can always look into more permanent options to have them stay on as a permanent resident with you as well.

Katie Russell 00:17:21 So just being informed if you have immigration counsel, checking in with them, having them do an audit internally of the types of workers that you have and what other options may be in place again for the long term health of the practice. If you've got good people and you want to have them there on a permanent basis, it's always something you can look into as well.

Keith Reynolds 00:17:40 All righty. That's all my questions, Katie. You got anything else that I didn't cover that you want to add?

Katie Russell 00:17:46 No. I mean, I would just say that it's, you know, there's a lot of misinformation. There's a lot of concern out there. But just being prepared, knowing what you can and cannot do in these situations really can take a lot of the heat off of a visit like that, and it can make folks feel a lot more comfortable. So that is something for practices to consider checking in with their immigration attorney or even their general practice attorney. If they have someone they don't mind communicating with an immigration attorney.

Katie Russell 00:18:13 It's just so good just to have that in place, even if you never use it. It's so nice to have it as a as an assurance.

Multiple Speakers 00:18:19 All righty. Thank you so much for joining us today. It's been an absolute pleasure.

Katie Russell 00:18:24 Thank you Keith. Always happy to speak with you.

Austin Luttrell 00:18:38 Once again, that was a conversation between Physicians Practice editor Keith Reynolds and Katie Russell, a partner at Brown Immigration Law in Cleveland, Ohio. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. Be sure to check back on Monday and Thursday mornings for the latest conversations with experts sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that Medical Economics and Physicians Practice published delivered straight to your email six days of the week. Subscribe to our newsletters at MedicalEconomics.Com and PhysiciansPractice.com

Austin Luttrell 00:19:12 Off the Chart: A Business of Medicine Podcast as executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell, Medical economics, Physicians Practice and Patient Care Online are all members of the MJH Life Sciences family. Thank you.