In early September, a lady, 9 months pregnant, walked into the emergency obstetrics unit of a Colorado hospital. Although the labor and supply workers caring for her anticipated her to have a easy supply, her case introduced issues virtually instantly.
The girl, who was born in central Asia, checked into the hospital with a sensible watch on her wrist, stated two hospital staff who cared for her throughout her labor, and whom the Guardian isn’t figuring out to keep away from exposing their hospital or sufferers to retaliation.
The system was not an extraordinary good watch made by Apple or Samsung, however a particular kind that US Immigration and Customized Enforcement (ICE) had mandated the girl put on always, permitting the company to trace her. The system was beeping when she entered the hospital, indicating she wanted to cost it, and he or she fearful that if the battery died, ICE brokers would assume she was making an attempt to vanish, the hospital staff recalled. She advised them that, simply days earlier, she had been placed on a deportation flight to Mexico, however the pilot refused to let her fly as a result of she was so near giving delivery.
The girl’s concern solely grew from there, in response to the hospital staff. Her supply wasn’t progressing the best way the care staff hoped, and he or she wanted a C-section, a process that requires medical doctors to make use of a cauterizing device to reduce bleeding. To stop doable burning and electrocution, sufferers are instructed to take off all jewellery or metals earlier than the surgical procedure. The obligatory watch had no approach to be simply eliminated, nor was details about whether or not it could be secure to put on through the process available. Hospital workers didn’t know methods to contact ICE to ask what to do. When hospital workers advised the girl they could have to chop the good watch off, she panicked, the employees stated.
Workers ultimately did take away the system, and ICE brokers didn’t present up on the hospital through the supply. The nurses stated they have no idea what occurred to the girl after she left the hospital together with her child.
The girl was one in every of three pregnant sufferers sporting a location-tracking good watch whom these two staff encountered of their ER in the previous few months, they stated.
BI Inc and different to detention
The watches are constructed and operated by BI Inc, an organization specializing in monitoring tech that runs the US authorities’s largest immigrant surveillance operation. This system, Various to Detention (ATD), permits choose immigrants to await their day in court docket at house moderately than in detention, supplied they subscribe to intense monitoring.
When immigrants are enrolled in ATD, they’re assigned a number of forms of supervision. Some need to put on an ankle monitor, some a sensible watch. Some are required to finish usually scheduled facial recognition scans at their house utilizing a BI Inc app, others are mandated to enter a BI Inc or ICE workplace for normal in-person check-ins.
The good watch, formally known as the VeriWatch, was launched two years in the past by BI Inc. It was first piloted beneath the Biden administration and framed as a extra discrete different to the much less digitally geared up ankle monitor, which BI additionally manufactures and provides to ICE. Because the Guardian beforehand reported, immigrants sporting the ankle displays have complained in regards to the stigma that comes with sporting the conspicuous system in addition to bodily ache attributable to the displays, together with electrical shocks and cuts from units which might be strapped on too tightly.
Almost 200,000 persons are presently enrolled in this system, and lots of of them have turn into more and more terrified of being thought of out of compliance because the Trump administration works to deport immigrants en masse. There have been a number of instances of individuals in this system exhibiting as much as a mandated, common in-person check-in with immigration officers, believing they are going to proceed within the ATD program, solely to be detained.
All three girls encountered by the Colorado hospital workers had been reluctant to take their displays off, fearing that doing so would set off an alert to ICE or BI Inc, the workers stated, even when eradicating the system was deemed medically obligatory.
One of many girls went into the ER for a C-section and was recognized with preeclampsia, a complication that may trigger important swelling. Workers had been fearful her smartwatch would lower off her circulation.
“She was in tears about it. She had this deep concern that ICE was going to come back to the hospital and take her child,” one of many workers stated. The hospital employee’s shift ended earlier than the affected person underwent the C-section. They stated they have no idea whether or not the workers who took over the affected person’s case satisfied her to chop off the watch.
The confusion and concern surrounding the wrist monitor induced delays within the hospital’s capacity to offer satisfactory and obligatory look after these girls, the employees stated, although the sufferers delivered their infants safely.
“Ready and making an attempt to determine these items out even when issues usually are not tremendous emergent could cause one thing emergent to occur,” one of many staff stated. “Generally in delivery, doing a C-section 20 minutes earlier than one thing dangerous occurs can forestall it.”
The employees identified that once they deal with sufferers sporting a monitor issued by the state Division of Corrections, there’s a protocol in place to take away it forward of medical procedures.
Trump’s chaotic crackdown
Hospital workers from throughout the US who spoke to the Guardian say the confusion introduced on by monitoring units is only one of a number of methods Donald Trump’s immigration crackdown is affecting medical care, and comes as immigrant sufferers are more and more terrified of in search of out remedy.
One of many workers on the Colorado hospital stated she’s had at leastthree pregnant sufferers present up for his or her first-ever prenatal appointment at anytime between 34 and 38 weeks – nicely into their third trimester and lengthy after pregnant girls are really helpful to start going to constant physician appointments.
In California, hospital staff have additionally observed a drop this 12 months in immigrants not simply in search of emergency care but in addition exhibiting up for normal physician visits or vaccinations, in response to the California Nurses Affiliation president, Sandy Reding.
“Clearly it has a cascading impact,” Reding stated. “For those who don’t see your physician usually then the outcomes are worse and also you wait till you might have a disaster to go to the ER.”
In Chicago, CommunityHealth, one of many largest volunteer-based well being facilities within the nation, documented an total drop in visits per affected person and affected person retention between 2024 and 2025 on account of immigration enforcement exercise within the metropolis. In June, the group noticed a 30% dip in sufferers exhibiting up for his or her appointments and round a 40% drop in sufferers choosing up their remedy since Trump took workplace.
Neither ICE nor BI Inc responded to requests for remark. ICE beforehand advised the Guardian that there isn’t any proof the ankle displays have induced bodily hurt and that the ATD program was efficient at rising court docket look charges amongst immigrants dealing with elimination.
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Obscure procedures, concrete issues
The dearth of process to have ankle or wrist displays eliminated in medical emergencies has affected extra than simply pregnant girls. In a single July 2025 case, ICE responded to a person’s request to take away his ankle monitor due to a medical concern by detaining him, in response to a court docket petition filed on his behalf by immigrant rights group Amica, which the Guardian reviewed.
The person got here to the US from Bangladesh to hunt political asylum, and was advised he needed to put on an ankle monitor whereas his declare was pending. Affected by nerve harm in a single leg, he obtained a notice from a medical clinic requesting the monitor be eliminated. His lawyer despatched the notice to the ICE officer on the case however by no means heard again. Throughout his first check-in on the BI places of work, the person introduced the medical notice to the BI Inc worker assigned to the case, who prompt the person would possibly be capable to transfer the ankle monitor to his different leg. However after the person’s lawyer known as ICE to inquire about shifting the ankle monitor, the BI case supervisor knowledgeable the person that ICE officers had been coming to the BI workplace to talk with him. They arrested and detained the person, in response to the petition.
“He defined that he was simply asking for the ankle monitor to be placed on the opposite leg, and the officer advised him it was ‘too late’,” the petition reads.
In 2009, ICE discontinued the usage of ankle displays for pregnant girls and other people whose medical situations made it “inappropriate” to put on them. However former BI Inc workers in addition to immigrants rights teams Amica and American Mates Providers Committee stated they’re involved that these exceptions usually are not all the time enforced. That exception additionally doesn’t apply to good watches, a June 2025 ICE memo reveals.
The ICE memo instructs company staffers to place ankle displays on anybody enrolled in ATD. Dawnisha M Helland, an ICE appearing assistant director within the administration of non-detained immigrants, wrote that the one group who wouldn’t be given ankle displays had been pregnant girls. As an alternative, pregnant girls in ATD would put on the good watch.
Although it resembles a typical client good watch, the VeriWatch isn’t much less restrictive than the ankle monitor. Just like the ankle monitor, the wrist watch can’t be eliminated by the particular person sporting it. ICE had the choice of utilizing a detachable model of the watch, in response to a 2023 request for data DHS printed. The company selected a special path; it presently solely makes use of a watch that can’t be eliminated besides by an ICE or approved BI agent, in response to two former DHS officers and two former BI workers.
Immigrants in this system usually are not advised what to do with their ankle or wrist displays in case of medical emergencies, and BI workers weren’t approved to approve the elimination of the displays with out first talking to ICE, the 2 former BI Inc. workers recalled.
There’s not all the time time in emergency instances to attend for approval from ICE to chop off the displays, the Colorado hospital staff stated. One of many Colorado workers stated they’re deeply involved about how this unremovable watch will proceed to influence susceptible pregnant girls.
“They’re taking a look at individuals who actually can’t converse up, who don’t have any authorized assets, who usually are not Americans, and are pregnant. They’re asking themselves what they will get away with when it comes to violating civil liberties for these sufferers,” the worker stated. “That’s the true pilot program: How far can they overreach?”
Inner alarm
Healthcare staff usually are not the one ones sounding the alarm over surveillance’s interference with medical care. Two former Division of Homeland Safety officers advised the Guardian that the dearth of protocols for immigrants surveilled beneath ATD with exigent medical points is a symptom of a bigger concern with the best way BI Inc and ICE run this system. Because the Guardian beforehand reported, immigrants surveilled beneath ATD and BI Inc workers alike have lengthy complained that this system is very discretionary. They stated that most of the choices about how, why or how lengthy a given particular person was mandated to put on an ankle monitor or a sensible watch had been left to particular person case staff.
BI Inc, which began off as a cattle monitoring firm, and its dad or mum firm the Geo Group, which develops detention facilities, non-public prisons, and rehabilitation services, have been given the unique DHS contract to function all elements of the ATD program since its inception in 2004. That’s regardless of earlier makes an attempt by ICE management beneath Joe Biden’s administration to interrupt the contract up into three elements moderately than awarding everything of the contract to Geo Group, an organization that has served as a touchdown spot for former ICE and DHS officers.
At its peak, BI Inc monitored roughly 370,000 immigrants beneath the Biden administration as a part of a coverage that put each head of family crossing the border on ATD. The tally decreased in 2025 to about 180,000 individuals, due partly to excessive prices of placing so many individuals on ATD, former DHS officers stated. As Trump’s second administration supercharged immigration enforcement and greenlit a $150bn surge in funding for ICE, although, Geo Group executives expressed confidence they might attain the identical peak by the second half of 2025. The aim, the executives have stated, is to watch all 7.5 million individuals listed on the federal authorities’s non-detained docket, the listing of non-citizens who haven’t been detained however are topic to elimination.
Nevertheless, the Trump administration has targeted on deportation and detention moderately than monitoring, and the variety of immigrants enrolled in ATD and sporting ankle displays or different GPS monitoring units has hovered round 180,000, a lot to the dismay of Geo Group executives.
“Now the depend has been pretty secure, which is slightly disappointing, clearly,” George Zoley, the GEO Group founder and government chairman of the board, stated through the firm’s November earnings name.
ICE awarded one other two-year-contract to BI Inc to handle ATD in September. Executives have stated they’re happy that the company is prioritizing utilizing the corporate’s dearer ankle displays on these immigrants already in ATD moderately than the more cost effective instruments like the corporate’s facial recognition app, Sensible Hyperlink.
Underneath the Biden administration, a number of departments inside DHS tried to deal with the dearth of constant coverage round how ICE ought to run ATD. In December 2022, DHS hosted 100 non-governmental organizations in addition to members of academia and personal business to debate methods to carry extra “uniform requirements to control” ATD. That two 12 months effort to draft tips in a doc, initially titled Non-Detained Administration Requirements, was finally scuttled by ICE and BI, stated Scott Shuchart, a former assistant director for regulatory affairs and police at ICE beneath the Biden administration. One other former DHS official confirmed his account. The draft requirements had been by no means made public.
“This system is absolutely structured for the good thing about BI and never for the good thing about the non-citizens who had been going to be managed by means of it,” stated Shuchart. “Subsequently ERO [ICE’s enforcement and removal arm] was extraordinarily immune to carry rationalization and constant coverage into it.”
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