A retired nurse cancels her surgery at Temple Hospital after being asked about her citizenship

Pamela Albright walked into Temple University Hospital in Philadelphia shortly before 1 p.m. on April 29, keeping her appointment for presurgery testing.

At the registration area she was directed to a check-in cubicle, where a worker asked her a series of questions, all of them routine, Albright said, until this one:

“Are you a U.S. citizen?”

Albright, a retired nurse who lives in Melrose Park, said she was taken aback. She stammered out a surprised, “Yes,” then thought for a moment and said, “Wait, I don’t want to answer that question,” she recalled.

The query posed no danger to her, she said in an interview with The Inquirer, having been born in Wisconsin.

But flashing through her mind were the ways that someone’s “no” answer on citizenship could find its way to immigration authorities, endangering those who might be undocumented. Simply asking about citizenship, she thought, could dissuade some people from seeking needed medical care.

“If it happened to me, how many people has it happened to? Are they still doing it?” she said. “This to me is a very serious breach.”

Albright, 72, said the incident and its aftermath caused her to cancel her surgery at Temple, and she is now evaluating other hospitals where she might seek care.

A Temple spokesperson, without identifying Albright by name, said the query about citizenship was a mistake.

“When we learned that a patient at Temple was recently asked this question in error, the patient was contacted by a member of our senior management team to explain the error and to let them know that we are sorry that this occurred,” director of media relations Jeremy Walter said in a statement.

Temple does not ask people about their citizenship during intake processes, nor is citizenship a factor in whether care is provided, he said. A recent update to Temple’s electronic medical-records system automatically made citizenship questions available to all hospitals using that system, but those questions are not included in Temple’s usual registration protocol and have been removed, he said.

The episode occurred at a time when the Trump administration is carrying out what it says will be the largest deportation campaign in American history, calling on federal agencies, state and local law enforcement, and everyday citizens to help identify people who might be undocumented.

Hospitals and healthcare facilities have become potential targets for immigration enforcement, as Trump revoked the “sensitive locations” policy that generally barred Immigration and Customs Enforcement agents from taking action in churches, schools, and other designated areas.

It appears uncommon for healthcare providers to inquire about citizenship, though hospitals in two conservative southern states, Florida and Texas, now are required to do so.

The goal, officials there say, is to determine the cost of providing medical care to undocumented immigrants and to potentially shift some of that financial burden onto them.

The 2023 Florida law says all hospitals that accept Medicaid must ask admitted patients and emergency-room visitors to state their status. Texas Gov. Greg Abbott’s 2024 executive order commanded the same.

A spokesperson for the National Hospital Association, asked if the organization offered guidance to hospitals on asking about citizenship, said, “We have nothing to add.”

All hospitals and healthcare providers, Temple’s Walter noted, are mandated to ask about citizenship and immigration status for patients covered by Medicare, Medicaid, and Affordable Care Act marketplaces, and Temple, like others, seeks that information during financial screening.

Undocumented immigrants are generally ineligible for those federal health-coverage programs.

Jasmine Rivera, executive director of the Pennsylvania Immigration Coalition, an advocacy group, said neither Temple nor other healthcare providers should ask people seeking care if they are citizens.

“What does my immigration status have to do with me being ill, with me needing an operation?” she said. “So if you’re asking me this, you must have ulterior motives. We’ve already seen people not go and get the care that they need.”

The chilling effect of Trump administration enforcement has frightened even those with legal status, she said, causing drops in visits to health clinics, food pantries, and churches. Undocumented people fear discovery could cause them to be detained and deported.

The National Immigration Law Center says healthcare providers have no legal obligation to ask about a patient’s immigration status, nor to report that information to federal authorities. The Health Insurance Portability and Accountability Act, known as the HIPAA privacy law, generally prohibits disclosure of personal health information without a patient’s consent, except when required by law, the center said.

Research shows that immigrants, whether lawfully present or not, use less healthcare than U.S.-born citizens. The KFF/LA Times Survey of Immigrants shows that immigrants who are likely to be undocumented seek and receive less care than legal immigrants and naturalized citizens.

Albright said that during her nursing career, she never asked patients about their citizenship, knowing it was irrelevant to their health needs.

That day at Temple, she said, she told the person taking her height and weight what had occurred during registration, saying, “I’m really kind of upset about what just happened.”

That person summoned the first of two supervisors, who listened to her concerns. One took down Albright’s phone number.

Albright finished her pre-op testing, but was no longer feeling good about having the surgery at Temple, she said. When she spoke to her surgeon, she said, she explained that she had decided to seek care elsewhere, that “it’s not ethical or right to ask citizenship status, and people are going to be afraid to get the healthcare they need.”

She wrote a letter to the editor of The Inquirer that was published on May 6, and after that a hospital vice president phoned, she said, explaining that posing the question on citizenship was a mistake.

Albright said the timing of the question concerned her, given the Trump administration’s effort to withhold billions of dollars in support from American universities that it wants to comply with certain demands. The worker who posed the question said it was a new question, Albright added.

“Is this an honest mistake, or an ‘obey-in-advance’ kind of thing?” she said. “Some people would turn around and leave. Somebody could get really sick or even be dying and not get the care they need.”