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Byron Cruz has encountered the sorts of situations that arise when someone is afraid a trip to a hospital could end with them being deported from the country.

He once helped a man injured on a construction site connect with a veterinarian who stitched closed a deep cut, for example. And Cruz says it’s common for pregnant women to seek his network’s help for deliveries.

“My number works as a 911 number for undocumented people,” he said, interviewed at his office in the Downtown Eastside. “We never announced our services, but my number has been given to people as the number they can call. That is very scary, because 911 is for emergencies.”

Cruz is an organizer with Sanctuary Health, a group that promises people can access care without fear of any complication that might arise from their immigration status.

He said that recent months have seen Metro Vancouver’s community of undocumented immigrants—which he estimated numbers between 3,000 and 5,000—grow increasingly reliant on such services that exist outside the province’s health-care system. A troubling statistic obtained from Fraser Health, which operates 12 hospitals throughout the Lower Mainland, may reveal why.

From January 2014 to October 2015, Fraser Health referred approximately 500 patients to the Canadian Border Services Agency (CBSA), the federal police force tasked with immigration enforcement.

“When we learned this, we were very shocked,” Cruz said. “This has to be taken very seriously.”

The issue of CBSA referrals gained widespread attention in 2014 when it was reported that the previous year transit police forwarded 328 incidents to CBSA. Those calls resulted in 62 investigations and at least one death: in December 2013, Lucia Vega Jiménez committed suicide while in CBSA custody after transit police arrested her for fare evasion.

Since then, the City of Vancouver has worked to designate itself a “sanctuary city”, where undocumented immigrants can access municipal services regardless of their status. But the rest of the region has not shown the same enthusiasm for such policies.

In a telephone interview, Fraser Health spokesperson Tasleem Juma confirmed that 500 calls to CBSA was an “approximation” for the period January 1, 2015, to October 7, 2015.

Juma claimed that Fraser Health does not know how many of those referrals resulted in CBSA launching an investigation, nor could she say how many ended in deportation. “Once the information goes to CBSA, what they do with it they don’t report back to us,” she said.

CBSA refused repeated requests for an interview. A spokesperson for the B.C. Ministry of Health told the Straight the province does not have a policy on immigration referrals and leaves those decisions to each service provider.

According to Juma, Fraser Health primarily contacts CBSA for billing purposes. She explained that nonresidents are charged different rates from residents and sometimes a call to CBSA is required to confirm a patient’s status. However, a Fraser Health policy document obtained by the Straight states that both physicians and nurses have “responsibilities” to attempt to see a nonresident discharged back to their home country.

Juma maintained that those sections are written to mean staff should ensure a nonresident will have access to health services after they leave Canada.

“We are not in the business of dealing with immigration issues,” she said. “When somebody needs emergency care and they come to us, we will take care of them.”

Juma added Fraser Health is open to revising guidelines for dealings with CBSA to harmonize its policies with providers across the region. “I think that would go a long way in relieving people’s concerns about coming to get health-care services,” she said.

Vancouver Coastal Health (VCH) and Providence Health Care, which operate Vancouver General and St. Paul’s hospitals, said they could not supply numbers for CBSA referrals by deadline.

Juan Solorzano, VCH executive director of population health, told the Straight VCH now requires that a patient give their permission before a call is made to CBSA. He noted they can refuse, in which case, if residency status cannot be confirmed for billing purposes, the patient will be charged the higher rates of a nonresident.

“That policy was updated in August 2015,” Solorzano said. “We will no longer call the border services agency without consent from the client.”

Regarding the 328 cases transit police sent CBSA in 2013, Anne Drennan, a spokesperson for the force, told the Straight her organization has implemented similar reforms. She revealed that in 2014, there were only 48 referrals. And so far in 2015, transit police have called CBSA just 18 times.

“We had no interaction with CBSA in November,” she said. “What changed was the policy. We no longer ask people about their status in the country.”

City councillor Geoff Meggs delivered an update on Vancouver’s efforts to become a sanctuary city. He reported that a draft document is essentially finished and expected to begin circulating among advisory councils before the end of the year. From there, he said, he hopes it will go before city council during the first half of 2016.

Meggs acknowledged that immigration is primarily a federal issue and so the city’s authority on such policies is limited. But he added that Vancouver is acting where it can.

“Immigration and residency status is not relevant to us,” he said. “So you are safe to do business with us.”