For years after her diabetes diagnosis, a patient at St. John’s Community Health had kept her blood sugar levels in check.

Then, federal immigration raids intensified across the region. She stayed home, fearing federal agents would detain her. The patient didn’t go to the grocery store to buy food and ate what was in her home — tortillas and coffee — for five days. Eventually, she canceled one of her regular appointments at a St. John’s clinic.

Staff with the health network, which operates 28 locations in Los Angeles County and the Inland Empire, called the patient and offered to do the appointment at her home, a new service that St. John’s launched last month in response to heightened concerns around immigration raids.

Medical staff took her blood sugar levels. She was on the verge of falling into a diabetic coma, said Jim Mangia, president and CEO of St. John’s.

“Thank God we got there before she had serious injury,” Mangia said. “That’s why it’s so important we provide this support.”

In the weeks since federal immigration raids have heightened, Mangia said appointment cancellation and no-show rates jumped to 30% across all St. John’s clinics in and around Los Angeles and the Inland Empire.

Typically, only about 8% to 9% of patients cancel or don’t go to appointments.

Undocumented immigrants and citizens alike are staying home out of fear that they could be detained by federal immigration authorities, St. John’s health officials say. When Trump took office in January, he also quickly stripped a Biden-era rule that protected hospitals, clinics, houses of worship, schools and other “sensitive locations” from immigration raids.

In response, St. John’s is meeting its patients where they’re at. If a patient doesn’t show up to their appointment, the clinic calls to see if they’d like to transition to a telehealth appointment.

When an in-person appointment is needed, a doctor, nurse and medical assistant can also see patients at their homes through the Healthcare Without Fear program launched last month. As immigration raids continue, Mangia said St. John’s is beefing up staffing for the program.

It’s the mission of St. John’s — a federally qualified network of nonprofit health centers and several mobile clinics that serve around 25,000 undocumented patients — to provide care for anyone, Mangia said.

“It’s a moral reflection of who St. John’s is,” Mangia said. “We believe that folks have a right to health care.”

When she clocks in at a St. John’s clinic in South Los Angeles, Dr. Olusanya Bukola sees the impact of recent immigration raids. Typically, the waiting room is filled with patients and crowds pouring into the parking lot and more than a dozen people lining up for walk-ins. Now, Bukola said just a handful of patients are at the clinic each morning.

When patients fear going to their doctor’s appointments, Bukola said it can disrupt their health and, in some cases, create public health concerns. A canceled or skipped appointment could mean that a patient with a chronic condition can’t get the care they need, a child can’t be vaccinated or that patients can’t get STI testing and other important screenings.

“It is very concerning for us as providers that we are not able to see our patients to continue what we already have (and) what is already well controlled,” Bukola said.

Bukola now spends a portion of her shift calling patients and converting their in-person appointments to telehealth visits. During an at-home visit before the recent increase in immigration raids, Bukola said she met with a patient who was documented but still feared leaving her home.

The Community Clinic Association of Los Angeles County, a coalition of nonprofit community health centers like St. John’s, is monitoring the impact of federal immigration enforcement across the county. So far, no-show and cancellation data from member clinics haven’t shown a clear trend, but the association’s president and CEO Louise McCarthy said that’s to be expected, given the size of L.A. and the varying populations that different clinics serve.

McCarthy said the association is working with partners to further assess the data to search for patterns among clinics across the county.

The association is also partnering with legal aid and community advocacy groups to educate community health clinics on how they can legally respond to federal immigration authorities, safeguard their patients’ protected health information and minimize impact on patients. By law, McCarthy said, federally qualified health centers are required to serve everyone in their community.

“There’s sort of a mismatch in policies here,” McCarthy said, when clinics are required to serve everyone but the potential for raids keeps them away.

Last week, a St. John’s mobile clinic had a run-in with federal immigration authorities in Downey, Mangia said.

Patients lined up for services when unmarked vehicles and armed agents approached, Mangia said. Clinic staff and security closed the gates and told agents they’d need to see a warrant signed by a judge before they would let immigration authorities inside. News spread to community members, who came out to protest their presence and film the authorities, and eventually the agents left.

“We’ve done a lot of training with our staff so that they could be prepared,” Mangia said, “to be able to prevent them from coming in and harassing our patients and kidnapping our patients.”

After the incident, Mangia said, St. John’s is doing more training with staff and increasing security at clinics and mobile clinics. Staff also educates patients on their rights in the event of an immigration enforcement.

At the same time, clinics like St. John’s are fighting proposed government funding cuts, including a proposal from Gov. Gavin Newsom to roll back Medi-Cal funding for undocumented people to offset a projected $12 billion state budget deficit. Newsom’s proposed cuts would gut $53 million from St. John’s annual budget, Mangia said.

Mangia plans to host a town hall with elected officials next week ahead of the June 27 deadline for lawmakers to finalize a state budget.

Community health clinics have made strides in Los Angeles County to provide care to more and more people, McCarthy said, but looming budget cuts could threaten that progress.

“We are in terrifying times,” McCarthy said, “when it comes to trying to predict what our future looks like.”