California Expands SB 81 Limits on Immigration Raids in Clinics

(CALIFORNIA) California moved to curb immigration raids in hospitals, clinics and schools, pressing ahead with new state rules even as federal authorities say they will not follow them. Under a package of laws now in force, including SB 81, health facilities across the state are directing staff to keep federal immigration agents out of private treatment areas unless officers present a valid search warrant or court order. State officials and health leaders say the measures are meant to shield patients and providers from disruptions that have rippled through emergency rooms, wards, and street medicine programs.

The clash sharpened after President Trump’s administration scrapped earlier federal guidance that discouraged enforcement in “sensitive locations” such as hospitals and schools in January 2025. California’s response aims to preserve access to care amid renewed enforcement activity. As of October 30, 2025, the state’s rules are in effect, but the Department of Homeland Security has told California authorities it will not comply with parts of the new framework, arguing the measures are unconstitutional under federal supremacy. That leaves hospitals and community clinics trying to follow state law while preparing for encounters with federal agents in lobbies, hallways and outside tents where medical teams treat patients on the street.

SB 81, the centerpiece of the effort, bars immigration agents from entering private areas of health facilities without a judge’s approval. Nurses’ stations behind locked doors, patient rooms, and treatment bays fall under those protections. Public portions of a hospital—lobbies, waiting rooms, and parking lots—remain open to federal officers. That limit matters, attorneys say, because federal agents can rely on the supremacy clause to operate in spaces where state law cannot close the door. California has paired SB 81 with new requirements for agents on school grounds and at public-facing sites, including a rule that immigration officers must clearly identify themselves and cannot wear masks during operations. State lawmakers also prohibited immigration enforcement on school campuses without a warrant, seeking to reduce fear among students and families.

The moves follow a run of incidents that alarmed providers and patients. In Glendale, staff at Glendale Memorial Hospital said a 36-year-old Salvadoran woman, Milagro Solis-Portillo, came under round-the-clock immigration surveillance while receiving care. Her case became a touchstone for providers who say bedside monitoring by armed officers undermines privacy and the patient’s ability to recover. In South Los Angeles, TikTok streamer Carlitos Ricardo Parias was taken to a hospital after being wounded during an immigration enforcement operation. Staff recalled that agents stayed in his room for almost a week, a presence that nurses said intimidated patients on the floor and complicated routine care.

Community clinics have reported uniformed officers in hospital lobbies and at neighborhood sites where the most fragile patients seek help. Clinicians described armed agents at front desks and, in one case, an officer waving a machine gun at a team serving the homeless. Street providers from St. John’s Community Health said masked officers in tactical gear surrounded a street medicine tent during an encounter that workers found jarring, prompting the organization to revisit safety protocols and legal training. St. John’s, a network of health centers in Los Angeles County, has expanded home medical visits and grocery deliveries for patients too afraid to leave their apartments while immigration activity intensifies nearby.

The scale of potential disruption is large. Community clinics in Los Angeles County serve more than 2 million patients each year, a sizable share of them immigrants who rely on walk-in access and steady relationships with providers to manage chronic conditions. Clinic directors say even brief enforcement activity near an entrance can empty waiting rooms for days, with missed vaccinations, untreated infections, and gaps in prenatal care that cascade into more serious health problems. The fear reaches beyond those without legal status, they add, hitting mixed-status families and refugee communities who avoid care when police or armed officers are visible near clinic doors.

Attorneys and advocates say California’s new rules are calibrated to defend patient privacy where the state has clear authority—behind a clinic’s secured doors—while acknowledging that federal officers can still stand in public areas. Sophia Genovese, a supervising attorney at Georgetown Law, has argued that state laws can protect private spaces, but federal authorities retain the ability to operate in public parts of hospitals under long-standing constitutional principles. That limit is shaping how hospital security teams are trained: staff are told to distinguish between restricted treatment zones, which now require a warrant for immigration access, and public-facing corridors where staff can document interactions but cannot physically block entry.

Legal groups note that immigration arrests inside health facilities remain uncommon, but word of even one encounter can spread across neighborhoods rapidly and drive people away from care. Tanya Broder, senior counsel at the National Immigration Law Center, has emphasized that while arrests are rare, the fear they generate is outsized and persistent. Providers say that chilling effect is visible every time a street clinic relocates after an immigration operation, only to find regular patients missing for weeks.

California officials argue the state’s approach aligns with long-held health privacy norms and federal patient confidentiality laws, even as DHS challenges the measures. SB 81 instructs facilities to treat immigration agents like any other law enforcement officers seeking access to areas where medical privacy applies: produce a warrant or wait in public space. The state’s education-focused provisions take a similar tack, telling school administrators they may not facilitate immigration enforcement on campus without judicial authorization and requiring clear identification from any officers who arrive.

Hospitals have begun building the state requirements into daily routines. Front desk staff are trained to ask whether officers possess a court order before allowing entry to treatment zones. Risk managers are updating policies to record any requests for patient information by federal agents, noting that medical records are protected absent a lawful demand. Security teams are revising badge access to keep non-staff out of care areas and are rehearsing de-escalation steps for encounters that could alarm patients. At the same time, many facilities are instructing staff not to interfere with officers in public spaces, where confrontation could create safety risks and would likely be futile.

Advocacy groups are distributing wallet cards and posters in English and Spanish that explain when staff can deny access and how patients can ask for privacy. Street medicine teams, accustomed to working in encampments and under freeway overpasses, are adjusting operations by mapping alternate sites and staging vehicles for rapid relocation if an immigration operation moves into view. St. John’s Community Health, which runs a wide network of clinics and community programs, has added grocery deliveries for patients who avoid outings on days when immigration raids take place nearby, and it has increased home visits for elderly patients who miss appointments after seeing armed officers near a clinic entrance.

Federal officials contend that California’s rules interfere with lawful enforcement and cannot bind federal agents. DHS has told state officials it will not follow some provisions, setting up potential tests in hospitals that straddle the line between private and public space. Health lawyers expect facilities to lean on documentation—security camera footage, incident reports, and requests for warrants—to create a record if disputes arise. The aim, hospital leaders say, is to keep focus on care while respecting both state law and the practical realities of federal presence in public areas.

For patients and providers, the immediate concern is whether the new rules can blunt the chilling effect of visible enforcement. Clinic managers in Los Angeles County say they will measure progress by the return of families who skipped pediatric visits during periods of stepped-up activity, the number of prenatal appointments completed on time, and whether fragile patients with diabetes, heart disease, or HIV keep showing up for labs and refills. They also point to the less visible work that now fills staff time: logging officer interactions, saving copies of any legal documents presented, and training new hires on when to escort agents to a waiting area and when to call a supervisor.

California’s health systems are also watching for federal court challenges that could narrow or delay parts of the framework. For now, the laws remain in force. Hospitals and clinics say they will continue to brief staff on SB 81 requirements and to refine plans for encounters that start in a lobby and threaten to spill into treatment zones. They argue that the rules are a practical way to keep exam rooms, ICU bays, and bedside care free of law enforcement activity, even as the front doors and sidewalks remain spaces where federal officers can stand.

The state’s legislative leaders have framed SB 81 as a targeted response to specific breakdowns in patient privacy rather than a broader attempt to block federal law. Health administrators echo that view, describing the rules as a roadmap to handle tense moments without shutting down access. With immigration raids continuing in parts of California and DHS rejecting portions of the state’s approach, the test in the coming months will be whether clinics and hospitals can hold the line inside their walls—and whether patients believe those walls will protect them.

The text of SB 81 is available on the California Legislature’s bill page.