In early December 2025, the waiting room at Inspire Change Clinic in south Minneapolis, which services a predominantly Hispanic population, was unusually quiet.
The reason: A few days earlier the Department of Homeland Security and US Immigration and Customs Enforcement (ICE), had begun a surge of arrests in the neighborhood that had the community scared and staying indoors.
“People actually needed care, but they’re not showing up because of the fear that they were having,” said Munira Maalimisaq, FNP-BC, founder and CEO of the clinic. She estimated that 50%-60% of the clinic’s patients were no-shows.
The experience mirrors findings from an analysis published in Pediatrics that showed sharp increases in missed appointments among Hispanic and Spanish-speaking children at a large pediatric health system in Minnesota during the high-profile immigration enforcement operations that lasted for about 2 months.
Researchers analyzed more than 129,000 outpatient appointments at Children’s Minnesota before, during, and after the operation, between October 2023 and March 2026. They adjusted to account for influenza seasons and winter weather.
The health system showed an overall increase of 3.2 missed appointments per 100 scheduled visits during the enforcement period (P = .04) in an interrupted times series analysis adjusting for preexisting trends and seasonal variation.
The largest increases occurred among Hispanic patients, whose rate increased by an estimated 11.5 missed appointments, and among Spanish-speaking families, at an increase of 16.8 missed appointments. The study itself began with an observation in clinic.
“I noticed this profound change in my clinical practice around the time of Operation Metro Surge in terms of which population of children were not showing up in my clinic,” said Asitha Jayawardena, MD, scientific director of ENT at Children’s Minnesota in Minneapolis. The analysis showed “what I was experiencing personally within my own practice was something that was affecting our entire institution as a whole.”
Compared with the same weeks during the previous 2 years, missed appointments increased by 51.2%, rising from 20.7% to 31.3% (P < .001). Among Spanish-speaking families, missed appointments increased by 80.4%, from 18.9% to 34.1% (P < .001). Families requiring interpretation experienced a 53.1% increase, from 18.4% to 28.1% (P < .001).
Missed appointments also increased among Somali-speaking families, with an estimated increase of 7.9 missed appointments per 100 scheduled visits (95% CI, 3.1-12.8; P = .001).
Delaying Preventive Care
Routine preventive visits, which can be especially important for detecting health and developmental problems early, were also affected. The study showed missed well-child appointments increased by 4.2 per 100 scheduled visits during the enforcement period (95% CI, 0.8-7.6; P = .02), while missed same-day and walk-in visits increased by 6.5 per 100 visits (95% CI, 1.5-11.5; P = .01).
Weekly requests to reschedule well-child visits increased 51% from the comparable periods in the prior 2 years (P = .002).
Previous research has linked missed routine health appointments to delayed diagnoses, progression of chronic illnesses, and more utilization of emergency care, the latter of which played out dangerously for one child at Inspire Change Clinic.
With the father detained by immigration enforcement, the mother diluted her child’s insulin rather than risk going outside.
By the time clinicians from the clinic reached the family at home, the child’s condition was life-threatening and they had to be taken to a hospital.
“It was such an emergency that we literally could not wait,” Maalimisaq said. “You know that your child needs this, but at the same time, ICE agents are sitting outside of that” clinic, pharmacy, or hospital, Maalimisaq said.
What Clinicians Can Do
The findings reflect trends across the country where ICE made concentrated efforts, said Theresa Cheng, MD, JD, assistant clinical professor of emergency medicine at UCSF-Zuckerberg San Francisco General Hospital and a civil rights attorney, who was not involved in the research.
“I think what we’re seeing now happening is what we feared and sort of expected all along,” she said.
Jayawardena said Children’s Minnesota responded by expanding telemedicine services during the period of increased enforcement.
The health system also temporarily relaxed no-show policies so families would not be penalized financially for missed visits. Community organizations also provided transportation to and from appointments and delivered medications.
Maalimisaq encouraged pediatric practices to make better use of technology and provided education on how to use patient portals such as MyChart in the family’s preferred language.
Cheng said other health systems should rethink where and how they deliver care, suggesting that practices consider partnerships with schools, churches, libraries, and community organizations to help set up mobile clinics to deliver services like vaccinations.
“Be creative about what care looks like in the broadest possible definition,” Cheng said.
Jayawardena, Cheng, and Maalimisaq reported no relevant conflicts of interest.
Lara Salahi is a health journalist based in Boston.
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