As President Trump continues to step up immigration enforcement, medical centers say the changes are indeed keeping immigrants out — of hospitals and clinics.

The deportation guidelines, first outlined in an executive order on Jan. 25, took more concrete form this week with a pair of memos from the Department of Homeland Security.

The executive order broadly expanded the categories of people targeted for deportation. Previously, agents were directed to focus on convicted criminals; individuals who were merely in the United States illegally were not prioritized for deportation. The executive order scrapped that policy.

Medical centers have traditionally been considered “sensitive locations,” like schools and places of worship, where federal agents usually would not enter. But individual immigrants are still scared to go to the doctor.

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“There’s just a lot of fear that ICE would raid our facility,” said Alex Armstrong, CEO of Alliance Medical Center, a community health center with a large Hispanic population north of Santa Rosa, Calif. He said that twice as many patients as normal canceled their appointments last week, some saying they were afraid of immigration officials. One man, who is a US citizen, missed an oncology appointment because his caretaker wouldn’t drive him, fearful of being stopped.

In Brooklyn, N.Y., rumors circulated last week that Immigration and Customs Enforcement agents were prowling the halls of the Kings County Hospital; while the rumors were false, a hospital spokesperson said that patients canceled appointments because of it.

Evidence that undocumented immigrants are avoiding clinics or hospitals because of the new guidelines is only anecdotal. But researchers have previously found that tightening of immigration policies have resulted in at least some increased fear in immigrant communities, with residents reluctant to leave their homes, go to the doctor, or take other actions they think might put themselves at risk.

In 2010, in the midst of an Arizona study on childhood obesity, which initially had nothing to do with immigration policy, the state legislature passed a bill expanding the authority of police officers to investigate individuals they suspected of being in the United States illegally — and the researchers noticed that people stopped showing up for medical care. (A later study also found that the passage of the bill was associated with less health care utilization.)

“Several providers described a drop in health maintenance, such as regular doctor visits, diabetes education, vaccines, prenatal care, HIV education, and procurement of medications, as the result of [the law],” the authors of the 2010 paper wrote.

It is unclear whether the recent spate of immigration raids is directly related to the executive order, the New York Times reported; Trump is claiming credit for fulfilling campaign promises, while DHS officials say it’s just business as usual.

At a clinic in Everett, Mass., Dr. Elisabeth Poorman, a primary care physician who sees mostly immigrant patients, said that fewer new patients are coming through the door — normally, she sees three or four a day, but in the past few weeks, there might only be one. And others are skipping follow-up appointments.

“On a day-to-day level, I have people who need to be on Coumadin and aren’t coming in,” Poorman said. “I have people who have diabetes, who need insulin, who aren’t getting it. I have people who had bad asthma and are too afraid to apply for insurance, so they’ll stay out for a while, but they’re going to get sicker and end up in the hospitals.”

“I think the implications of what’s going on right now are going to be felt by the health community for decades to come,” Poorman said.

This article is reproduced with permission from STAT. It was first published on Feb. 24, 2017. Find the original story here.