Professional Documents
Culture Documents
Petitioners,
- against -
Respondents.
TABLE OF CONTENTS
Page
INTRODUCTION .......................................................................................................................... 1
ARGUMENT.................................................................................................................................. 6
The Executive Order Harms Medical Institutions and Healthcare in America .............................. 6
I. The Vital Role That Immigrant Doctors, Medical Researchers and Healthcare
Workers Perform in the American Healthcare System....................................................... 6
II. The Executive Order Interferes With Patient Care and Medical Science in the
United States ..................................................................................................................... 10
B. The Executive Order Disrupts the Match Program That Assigns Medical
School Graduates to Hospitals .............................................................................. 14
CONCLUSION............................................................................................................................. 20
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 3 of 23 PageID #: 2004
Amici are medical institutions, organizations, advocacy groups, and individual physicians
throughout the United States that have an interest in providing optimal healthcare services to
Executive Order at issue in this case is detrimental to the care of patients both in the United
States and across the globe as well as the advancement of medical science. Amici highly value
the contributions of foreign-born healthcare providers and believe that they are a critical pillar of
INTRODUCTION
Connelie, 435 U.S. 291, 294 (1978). In 2010, 12.9 percent of the population was foreign-born
and one out of every four Americans had at least one parent born outside the United States.1 The
national immigrant character is reflected in the American medical community: about 28 percent
America were born in a foreign country.2 Among their many contributions to American
healthcare, foreign-born doctors disproportionately serve in small towns and rural areas that
1
Brief of Technology Companies and Other Businesses as Amici Curiae In Support of
Appellees, Washington v. Trump, No. 17-35105, 2017 WL 526497 (9th Cir. Feb. 6, 2017) (citing
sources).
2
See Marcia D. Hohn et al., Immigrants in Health Care: Keeping Americans Healthy Through
Care and Innovation, George Mason University Institute for Immigration Research, at 2-5 (June
2016),
http://s3.amazonaws.com/chssweb/documents/22231/original/health_care_report_FINAL_20160
629.pdf?1467209316.
3
See Anupam B. Jena, Trumps Immigration Order Could Make It Harder To Find A
Psychiatrist or Pediatrician, FiveThirtyEight (Feb. 3, 2017),
http://fivethirtyeight.com/features/trumps-immigration-order-could-make-it-harder-to-find-a-
psychiatrist-or-pediatrician.
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 4 of 23 PageID #: 2005
Contrary to the immigrant traditions and ideals of the United States, the Presidents
January 27, 2017 Executive Order (Executive Order or Order) imposed a ban on entry into
the United States from seven predominantly Muslim countries for 90 days regardless of
individual circumstances, even when the alien already had a valid immigrant or nonimmigrant
visa. Caught in the widespread chaos and confusion created by the Executive Order are
American medical institutions, an estimated 15,000 physicians plus numerous other medical
Amici are medical institutions, organizations, advocacy groups, and individual physicians
in Connecticut, New York and other areas of the United States that serve patients, train
physicians, conduct important medical research, and develop public policies advancing health
solutions for patients and providers. Together the Amici treat thousands of patients, often with
personnel who are foreign nationals, including many from the countries covered by the
Executive Order. Amici are deeply concerned about the Executive Order, which has caused:
visas of medical personnel, which interferes with their patients medical needs and
including foreign medical schools, with American hospital residency and fellowship
programs, including approximately 1,000 doctors from the seven affected countries5;
4
See Donald G. McNeil Jr., Trumps Travel Ban, Aimed at Terrorists, Has Blocked Doctors,
N.Y. Times (Feb. 6, 2017), https://www.nytimes.com/2017/02/06/health/trump-travel-ban-
doctors.html.
5
See Melanie Evans, Hospitals Weigh Difficult Choice Amid Travel-Ban Uncertainty, Wall St. J.
(Feb. 12, 2017), https://www.wsj.com/articles/hospitals-weigh-difficult-choice-amid-travel-ban-
uncertainty-1486900805 (reporting that according to the Association of American Medical
Colleges roughly 1,000 doctors who applied for U.S. residency slots this year are from the
seven countries included in the White Houses travel ban.).
2
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 5 of 23 PageID #: 2006
knowledge; and
deliver humanitarian healthcare, especially to foreign children and others from the
affected countries.
If, as contemplated in the Order, and as stated by key administration officials, the ban is
extended to other countries,6 then the harm to the American healthcare infrastructure and the
medical needs of patients both in and outside the United States will be exponentially magnified.
For these reasons, the American Medical Association expressed concern that this
executive order is negatively impacting patient access to care and creating unintended
consequences for our nations healthcare system.7 The American Hospital Association
immigration could adversely impact patient care, education and research.8 Patients have also
expressed their concern. In a recent article in the New England Journal of Medicine, a Muslim
6
See Face the Nation Transcript January 29, 2017: Priebus, McCain, Ellison, Face the Nation
(Jan. 29, 2017), http://www.cbsnews.com/news/face-the-nation-transcript-january-29-2017-
priebus-mccain-ellison/ (Now, you can point to other countries that have similar problems, like
Pakistan and others. Perhaps we need to take it further.).
7
AMA Urges Trump Administration to Clarify Immigration Executive Order, American Medical
Association (Feb. 1, 2017), https://www.ama-assn.org/ama-urges-trump-administration-clarify-
immigration-executive-order.
8
Rick Pollack, Statement on President Trumps Executive Order on Immigration, American
Hospital Association, (Jan. 30, 2017), http://www.aha.org/presscenter/pressrel/2017/013017-pr-
immigration.shtml.
3
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 6 of 23 PageID #: 2007
doctor recounted that following the Executive Order one of his patients said, I voted for Trump,
but there is no way Im going to let him take you away, doctor.9
Amici respectfully urge the Court, as it weighs the public interest-element of the test for
injunctive relief, to consider the damage done by the Executive Order to patient care, medical
education, and medical science in the United States. See Park Irmat Drug Corp. v Optum Rx,
Inc., 152 F.Supp.3d 127, 142 n.10 (S.D.N.Y. 2016) (noting that the public interest in
uninterrupted and safe medical care is a valid consideration in ruling on a motion for a
preliminary injunction).
CASE BACKGROUND
On January 27, 2017, President Trump signed an Executive Order titled Protecting the
Nation from Foreign Terrorist Entry into the United States. Among other things, the Executive
Order suspends for 90 days immigrant and nonimmigrant entry of aliens from countries referred
to in Section 217(a)(12) of the Immigrant and Nationality Act (INA), 8 U.S.C. 1187(a)(12)
namely aliens from Iraq, Iran, Libya, Somalia, Sudan, Syria, and Yemen.10
The Order provides for limited exceptions to the 90-day suspension of entry for foreign
nationals traveling on various diplomatic visas and provides that the Secretaries of State and
Homeland Security can issue visas on a case-by-case basis when in the national interest, but
9
Ahmad Masri and Mourad H. Senussi, Trumps Executive Order on Immigration Detrimental
Effects on Medical Training and Health Care, New England J. Med. (Feb. 1, 2017),
http://www.nejm.org/doi/full/10.1056/NEJMp1701251#t=article.
10
The statute incorporated into the Executive Order, 8 U.S.C. 1187, sets out the requirements of
a visa waiver program, and then disallows such waivers for nationals of Iraq or Syria or other
countries designated by the State Department as a country with a government that has repeatedly
supported acts of international terrorism (i.e., Iran and Sudan), and any other country that has
been designated a country or area of concern by the Secretary of Homeland Security (i.e., Libya,
Somalia, and Yemen). Section 1187(a)(12)(A)(i) disallows visa waivers to any alien who has
been present in any of those countries after March 2011.
4
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 7 of 23 PageID #: 2008
provides no process or guidance for the grant of such exceptions.11 The Order also suspends the
United States Refugee Admissions Program for 120 days, suspends indefinitely the entry of all
refugees from Syria, and provides for priority consideration for future refugee claims for people
In the days after it was announced, the Order and the lack of clarity surrounding its
implementation caused widespread confusion.12 As the Ninth Circuit put it, [i]t was reported
that thousands of visas were immediately canceled, hundreds of travelers with such visas were
prevented from boarding airplanes bound for the United States or denied entry on arrival, and
some travelers were detained.13 Moreover, after the Order went into effect, government
officials barred lawful permanent residents (green card holders) from entering the country as the
language of the Order categorically denies entry to all aliens from the seven countries at
issue.14 Although a White House counsel subsequently issued authoritative guidance that the
Order does not apply to green card holders,15 the Order thus far has not been amended to reflect
11
Exec. Order No. 13769, 82 Fed. Reg. 8977, 8978 3(g) (Jan. 27, 2017); Washington v. Trump,
No. 17-35105, 2017 WL 526497, at *11 (9th Cir. Feb. 9, 2017) (holding that the case-by-case
waiver provision was not a sufficient safety valve for the harm caused by the Order and that
the Government offered no explanation for how these provisions would work in practice.).
12
See Laura King et al., Confusion reigns at U.S. airports as protests of Trump executive order
enter second day, L.A. Times (Jan. 29, 2017), http://www.latimes.com/nation/la-na-pol-trump-
immigration-vetting-20170129-story.htmll; Miriam Jordan et al., Donald Trumps Immigration
Order Sparks Confusion, Despair at Airports, Wall St. J. (Jan. 29, 2017),
https://www.wsj.com/articles/donald-trumps-immigration-order-sparks-confusion-despair-at-
airports-1485709114.
13
Washington v. Trump, No. 17-35105, 2017 WL 526497, at *2 (9th Cir. Feb. 9, 2017).
14
See, e.g., Aziz v. Trump, No. 1:17-CV-116, 2017 WL 580855, at *3 (E.D.Va. Feb. 13, 2017)
(finding that the Executive Order was initially applied to legal permanent residents (LPRs) and
that the government conceded that Customs and Border Patrol . . . initially stopped several
LPRs at the border in the 24 to 48 hours after the EO was signed.).
15
Donald F. McGahn II, Authoritative Guidance on Executive Order Entitled Protecting the
Nation from Foreign Terrorist Entry into the United States, Memorandum to the Acting
Secretary of State, the Acting Attorney General, and the Secretary of Homeland Security (Jan.
27, 2017), http://www.politico.com/f/?id=00000159-fb28-da98-a77d-fb7dba170001 ([T]o
5
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 8 of 23 PageID #: 2009
this clarification and, in any event, considerable uncertainty exists over the authority of a White
By its terms, the blanket ban in the Order could expand beyond the seven countries.
Sections 3(d) and 3(e) direct the Secretary of Homeland Security and the Secretary of State to
submit to the President a list of additional nations whose citizens would be prohibited from
entering the United States based on the adequacy of a nations response to U.S. information
requests. High-ranking Administration officials, such as the White House Chief of Staff, have
suggested that broadening the Order may well occur in the near future.17
ARGUMENT
immigrants.18 Approximately fifteen percent of registered nurses,19 and 20.9 percent of direct
remove any confusion, I now clarify that Sections 3(c) and 3(e) do not apply to [lawful
permanent residents].).
16
See Washington v. Trump, No. 17-35105, 2017 WL 526497, at *8 (9th Cir. Feb. 9, 2017).
([W]e cannot rely upon the Governments contention that the Executive Order no longer applies
to lawful permanent residents. The Government has offered no authority establishing that the
White House counsel is empowered to issue an amended order superseding the Executive
Order.).
17
See supra note 6.
18
See Marcia D. Hohn et al., Immigrants in Health Care: Keeping Americans Healthy Through
Care and Innovation, George Mason University Institute for Immigration Research, at 2-5 (June
2016),
http://s3.amazonaws.com/chssweb/documents/22231/original/health_care_report_FINAL_20160
629.pdf?1467209316.
6
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 9 of 23 PageID #: 2010
care workers are foreign-born.20 And those numbers are growing because U.S.-born HCPs alone
cannot meet the medical needs of Americans. For example, the number of foreign-born direct
care workers, which include home health aides and personal care assistants, nearly doubled
Foreign-born HCPs will be even more indispensable in the coming years. An April 2016
includes all accredited medical schools and major teaching hospitals in the United States,
estimates a current shortfall of between 29,000 and 46,000 physicians in the United States and
projects a total physician shortfall of between 61,700 and 94,700 physicians by 2025.22
Similar shortfalls exist for direct care workers and registered nurses because the number
and proportion of older adults in the United States has grown at a rate the Center for Disease
Control and Prevention (CDC) has called unprecedented in our nations history.23 Meeting
the medical needs of an aging population will require five million direct care workers by 2030, a
48 percent increase from 2010 levels. In 2008, the United States faced a shortage of over
135,000 registered nurses.24 By 2025, the shortfall of registered nurses is projected to be around
19
Id.
20
Peggy G. Chen et al., Policy Solutions to Address the Foreign-Educated and Foreign-Born
Health Care Workforce in the United States, Health Affairs (2013),
http://content.healthaffairs.org/content/32/11/1906.
21
Id.
22
2016 Update - The Complexities of Physician Supply and Demand: The Projections from 2014
to 2025, IHS Report (Apr. 5, 2016),
https://www.aamc.org/download/458082/data/2016_complexities_of_supply_and_demand_
projections.pdf.
23
Center for Disease Control and Prevention, The State of Aging & Health in America 2013,
Atlanta, GA: Ctr. for Disease Control and Prevention, United States Department of Health and
Human Services (2013), https://www.cdc.gov/aging/pdf/State-Aging-Health-in-America-
2013.pdf.
24
Nursing Shortage, American Association of Colleges of Nursing (Apr. 24,
2014),http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage.
7
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 10 of 23 PageID #: 2011
260,000, more than twice as large as any nurse shortage experienced since the introduction of
Medicare and Medicaid in the mid-1960s.25 The American Association of Colleges of Nursing
notes that nursing schools across the country are struggling to expand capacity to meet the
The gap between Americans medical needs and the supply of healthcare professionals
would be dramatically worse without the admission to the United States of foreign-born HCPs.
In 2016 alone, 7,460 non-U.S. citizen students/graduates of international medical schools applied
to be matched to a U.S. residency or other training program, accounting for 21 percent of the
total number of applicants.27 As noted, the percentage of foreign-born direct care workers has
HCPs from the seven banned countries play a vital role in meeting the increasing
American healthcare demands. It has been reported that more than 15,000 doctors from the
seven nations practice in the United States, including almost 9,000 from Iran, 3,500 from Syria,
and more than 1,500 from Iraq.28 Among this years foreign applicants for American residency
25
Peter I. Buerhaus et al., The Recent Surge in Nurse Employment: Causes and Implications,
Health Affairs (June 12, 2009), http://content.healthaffairs.org/content/28/4/w657.full.
26
Nursing Shortage, American Association of Colleges of Nursing (Apr. 24,
2014),http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage.
27
Results and Data, 2016 Main Residency Match, National Residency Matching Program
(2016), http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-
2016.pdf.
28
Donald C. McNeil Jr., Trumps Travel Ban, Aimed at Terrorists, Has Blocked Doctors, N.Y.
Times (Feb. 6, 2017), https://www.nytimes.com/2017/02/06/health/trump-travel-ban-
doctors.html?_r=0.
29
See supra note 5.
8
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 11 of 23 PageID #: 2012
the country that encompass medically underserved areas (MUAs), medically underserved
government tracks access to medical care around the country, and designates MUAs and MUPs
based on the local ratio between the population and the number of healthcare providers, the
percentage of the population either below the poverty level or above the age of 65, and the infant
mortality rate.30 The government also designates HPSAs, which demarcate areas that lack
adequate support for healthcare.31 While there are different methodologies used by the
government to determine MUAs, MUPs, and HPSAs, they all can result in the designation of
MUAs, MUPs, and HPSAs exist in every single state, but they are particularly prevalent
in poorer and more rural areas.33 A 2016 AAMC study found that it would take 53,000 to 96,000
30
Medically Underserved Areas and Populations (MUA/Ps), Health Resources and Services
Administration (Oct. 2016), https://bhw.hrsa.gov/shortage-designation/muap.
31
Health Professional Shortage Areas (HPSAs), Health Resources and Services Administration
(Oct. 2016), https://bhw.hrsa.gov/shortage-designation/hpsas.
32
HPSA and MUA/P Program Overview, Michigan Department of Health and Human Services,
http://www.michigan.gov/mdhhs/0,5885,7-339-71551_2945_47514-176068--,00.html.
33
For a map of MUAs showing how widespread MUAs are over the geography of various states
see Quick Maps Medically Underserved Areas/Populations (MUA/P), Health Resources and
Services Administration,
https://datawarehouse.hrsa.gov/Tools/MapToolQuick.aspx?mapName=MUA (last visited Feb.
15, 2017). See also, Donald G. McNeil Jr., Trumps Travel Ban, Aimed at Terrorists, Has
Blocked Doctors, N.Y. Times (Feb. 6, 2017),
https://www.nytimes.com/2017/02/06/health/trump-travel-ban-doctors.html (noting doctor
shortages in parts of Brooklyn and the Bronx).
9
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 12 of 23 PageID #: 2013
additional physicians in those areas to provide the same level of care as patients in the rest of
America experience.34
Recognizing the critical role of foreign-born physicians in meeting the health needs in
MUAs, MUPs, and HPSAs, the federal government provides incentives for foreign-born
physicians to work in these areas. For example, physicians who pursue medical education in the
United States on a J-1 visa (discussed in more detail infra Section II-A) typically must leave the
country for at least two years after completing their education programs. That requirement can
be waived, however, under the Conrad 30 Waiver Program for J-1 visa holders who provide
three years of care or more to MUAs, MUPs or HPSAs to address[] the shortage of qualified
doctors in medically underserved areas.35 These incentives impact the number of foreign
analysis website, [i]n counties with the greatest physician shortage, 25.6 percent of physicians
had trained abroad, compared with 19.2 percent in the low-shortage counties.36
II. The Executive Order Interferes With Patient Care and Medical Science in the
United States
Even before the Executive Order, foreign-born HCPs had to overcome significant
obstacles to work in the United States. Beyond the personal challenges of leaving behind
34
New Research Confirms Looming Physician Shortage, Association of American Medical
Colleges (Apr. 5, 2016),
https://www.aamc.org/newsroom/newsreleases/458074/2016_workforce_projections_04052016.
html.
35
Conrad 30 Waiver Program, U.S., Citizenship and Immigration Services (May 5, 2014),
https://www.uscis.gov/working-united-states/students-and-exchange-visitors/conrad-30-waiver-
program.
36
Anupam B. Jena, Trumps Immigration Order Could Make It Harder To Find A Psychiatrist
or Pediatrician, FiveThirtyEight (Feb. 3, 2017), http://fivethirtyeight.com/features/trumps-
immigration-order-could-make-it-harder-to-find-a-psychiatrist-or-pediatrician/.
10
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 13 of 23 PageID #: 2014
families and friends, they also must meet a variety of government and institutional requirements.
For example, residency and fellowship applicants must be certified by the Educational
Commission for Foreign Medical Graduates, which includes checks on English language
proficiency, medical education credentials and clinical skills.37 In addition, foreign-born HCPs
must obtain H-1B or J-1 visas, each with stringent requirements, including security screening
procedures.
Thousands of foreign-born HCPs work in the United States under H-1B visas,38 which
visa, an applicant must have a job offer from a United States employer that has received
Department of Labor certification. For doctors, this often requires acceptance to a residency or
other training program at a medical institution, which includes vetting by the institution of the
applicants qualifications, validity of their medical degree and test scores. The applicants are
then further screened by both the Department of State and Customs and Border Protection,
including an in-person interview of the applicant at the United States embassy or consulate.40
37
See Requirements for Certification, Educational Commission for Foreign Medical Graduates
(Sep. 7, 2016), http://www.ecfmg.org/certification/requirements-for-certification.html.
38
See Characteristics of H1B Specialty Occupation Workers, United States Citizenship and
Immigration Services, at 20 (June 26, 2013),
https://www.uscis.gov/sites/default/files/USCIS/Resources/Reports%20and%20Studies/H-
1B/h1b-fy-12-characteristics.pdf, (showing that there were over 10,000 approved H-1B petitions
for medical personnel in 2011 and nearly 7,000 in 2012).
39
The visa permits its holder to remain in the United States for three years, although for some
visa-holders, that period can be extended for up to three more years. See H-1B Specialty
Occupations, DOD Cooperative Research and Development Project Workers, and Fashion
Models, United States Citizenship and Immigration Services (Mar. 16, 2016),
https://www.uscis.gov/working-united-states/temporary-workers/h-1b-specialty-occupations-
dod-cooperative-research-and-development-project-workers-and-fashion-models. See also
Understanding H-1B Requirements, United States Citizenship and Immigration Services,
https://www.uscis.gov/eir/visa-guide/h-1b-specialty-occupation/understanding-h-1b-
requirements (laying out the requirements for obtaining an H-1B visa).
40
H-1B Specialty Occupations, DOD Cooperative Research and Development Project Workers,
and Fashion Models, United States Citizenship and Immigration Services (Mar. 16, 2016),
https://www.uscis.gov/working-united-states/temporary-workers/h-1b-specialty-occupations-
11
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 14 of 23 PageID #: 2015
Other foreign nationals enter the United States under the J-1 visa program, which covers
thousands of foreign medical personnel.41 A category of J-1 visas is reserved specifically for
foreign physicians who come to the United States for graduate medical education or training at
accredited American medical institutions.42 Beyond government scrutiny, participants in the J-1
Alien Physician program must also be admitted to a U.S. residency program, pass certain
medical board exams, and prove their competency in oral and written English.
In short, doctors and medical professionals entering the country have been thoroughly
vetted under existing procedures. Government screening alone is extensive, as ten former high-
ranking officials, explained in a declaration submitted to the Ninth Circuit: the United States
has developed a rigorous system of security vetting, leveraging the full capabilities of the law
enforcement and intelligence communities, which is applied to visa applicants multiple times.43
Unless enjoined, the Executive Order may prove to be a bridge too far for foreign HCPs.
For example, Seyed Soheil Saeedi Saravi, a young Iranian scientist, had been scheduled to travel
12
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 15 of 23 PageID #: 2016
the blanket ban set forth by the Executive Order, however, both his and his wifes visas were
suspended indefinitely, despite the extensive vetting process they had already undergone.45
Similarly, on January 28, 2017, the day after issuance of the Executive Order, Dr. Suha
Abushamma, a Sudanese national who is an internal medicine resident at the Cleveland Clinic
with an H-1B visa, was denied re-entry, detained for nine hours at John F. Kennedy International
Airport, and then removed.46 More generally, current holders in the United States of J-1 and H1-
B visas from the seven countries are unlikely to have their visas renewed under the Executive
These adverse effects were recognized by the Ninth Circuit in Washington v. Trump,
where the court observed that university students and faculty in the State of Washington, who
hold visas similar to those of foreign doctors, cannot travel for research, academic
collaboration, or for personal reasons, and their families cannot visit. As a result, the
Washington schools cannot consider attractive student candidates and cannot hire faculty from
the seven affected countries, which they have done in the past. 47 This is no less true of
Americas foreign-born medical students and faculty and our medical schools and hospitals.
44
Michael D. Shear et al., Judge Blocks Trump Order on Refugees Amid Chaos and Outcry
Worldwide, N.Y. Times (Jan. 28, 2017), https://www.nytimes.com/2017/01/28/us/refugees-
detained-at-us-airports-prompting-legal-challenges-to-trumps-immigration-order.html.
45
Id.
46
Ann Domeck, Cleveland Clinic resident forced to leave U.S. over executive order sues
President Trump, Fox8 (Jan. 31, 2017), http://fox8.com/2017/01/31/cleveland-clinic-resident-
forced-to-leave-us-over-executive-order-sues-president-trump/. See also Amended Petition for
Writ of Habeas Corpus and Complaint for Declaratory and Injunctive Relief, Abushamma v.
Trump, No. 1:17-cv-00488-CBA, https://www.propublica.org/documents/item/3439950-
Amended-petition-for-writ.html.
47
Washington v. Trump, No. 17-35105, 2017 WL 526497, at *4 (9th Cir. Feb. 9, 2017).
13
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Moreover, none of this is lost on foreign-born scientists and HCPs. A Belgian researcher
observed that the travel ban makes you think twice about starting a career in the U.S.48
Chemist Maria Escribano, from Spain, a postdoctoral researcher at Stanford University, said
this is terrifying for science, research, education, and the future of our planet. I guess its time
B. The Executive Order Disrupts the Match Program That Assigns Medical
School Graduates to Hospitals
In its short existence, the Executive Order is already interfering with the National
Resident Matching Program (NRMP), also known as the Match. The Match uses a
graduates of foreign medical schools, in residency and fellowship positions, most often in
teaching hospitals. In the 2017 Match, there are more than 42,000 residency applicants --
including 7,000 foreign-born graduates (roughly 1,000 of whom are from the seven affected
countries). The Match, which has been in place since 1952, has a tight, multi-step schedule for
the submission of applicant preferences and decisions by residency programs. For the 2017
academic year, registration for the Match began on September 15, 2016.50 After registering for a
Match and completing interviews, applicants are to submit by February 22, 2017 less than a
week from now a ranked list of programs at which they wish to train.51 At the same time,
48
Seema Yasmin, Trump Immigration Ban Can Worsen U.S. Doctor Shortage, Hurt Hospitals,
Scientific American (Feb. 1, 2017), https://www.scientificamerican.com/article/trump-
immigration-ban-can-worsen-u-s-doctor-shortage-hurt-hospitals/.
49
Sharon Begley, Fearful of a Trump administration, many in research call for a tutorial for
the president-elect, Stat (Nov. 9, 2016), https://www.statnews.com/2016/11/09/scientists-trump-
new-reality/.
50
2017 Main Residency Match Calendar, National Resident Matching Program,
http://www.nrmp.org/residency/main-match-events/ (last visited Feb. 12, 2017).
51
Id.
14
Case 1:17-cv-00480-CBA Document 156 Filed 02/16/17 Page 17 of 23 PageID #: 2018
program directors submit their ranked list of applicants.52 The Match then applies the algorithm
to match applicants to programs with decisions announced on March 17, 2017 and residents
As a result of the Executive Order, the roughly 1,000 applicants from the seven covered
countries cannot be sure that they will be allowed to enter the United States by the start of the
residency programs.54 By the same token, the residency programs cannot be certain when those
applicants will be able to come to the United States, if at all. Thus, the program have to make
the difficult choice between selecting qualified applicants who may be barred from entering the
country, or skipping over those applicants out of fear of staffing shortages and budgetary and
Medicine, the banning of applicants from Syria or Iran will result in a residency program with
holes in it and not enough doctors to take care of the patients that the program is responsible
for.55 Atul Grover, the Executive Vice-President of the AAMC, put it this way: the
52
Id.
53
Id.
54
Michael Hiltzik, Another casualty of Trumps Muslim ban: U.S. medical training and rural
healthcare, L.A. Times (Feb. 1, 2017), http://www.latimes.com/business/hiltzik/la-fi-hiltzik-ban-
medical-20170201-story.html; see also Ahmad Masri and Mourad H. Senussi, Trumps
Executive Order on Immigration Detrimental Effects on Medical Training and Health Care,
New England J. Med. (Feb. 1, 2017),
http://www.nejm.org/doi/full/10.1056/NEJMp1701251#t=article.
55
Seema Yasmin, Trump Immigration Ban Can Worsen U.S. Doctor Shortage, Hurt Hospitals,
Scientific American (Feb. 1, 2017), https://www.scientificamerican.com/article/trump-
immigration-ban-can-worsen-u-s-doctor-shortage-hurt-hospitals/.
56
Olga Khazan, Trumps Immigration Order Might Cost Thousands of Americans Access to a
Doctor, The Atlantic (Jan. 30, 2017),
https://www.theatlantic.com/health/archive/2017/01/trumps-immigration-order-will-cost-
thousands-of-americans-access-to-a-doctor/515016/.
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One teaching hospital in Ohio already instructed its staff to cancel residency offers to
medical students from some countries.57 Highlighting the dilemma medical institutions now
face, an official of that institution acknowledged that the Executive Order per force eliminates
applicants based on country of origin.58 Others are reluctantly considering not selecting
applicants based on their country of origin because, according to Vinny Arora, an assistant dean
at the University of Chicagos medical school, [p]rogram directors want to match the most
qualified candidates, but they also want to be sure the interns they match can start and dont
experience visa issues.59 The St. Vincent Charity Medical Center in Cleveland issued a
statement that we may be forced to turn away our best candidates for fear that their
citizenship will be an obstacle. This is detrimental to both the advancement of medicine and
As the NRMP, which administers the Match, points out: The consequences of the
Executive Order are far-reaching for Match applicants, and the upheaval it is causing is
extensive. The affected applicants have worked hard for many years to achieve their goal of
becoming physicians, and they should not be denied that opportunity because of a blanket policy
57
Shashank Bengali et al., Families hoping to make the U.S. their home scramble to rearrange
their lives, L.A. Times (Jan. 27, 2017), http://www.latimes.com/world/la-fg-refugees-order-
reaction-20170127-story.html; see also Dan Diamond, Trumps travel ban rattles medical
residency programs, Politico (Jan. 31, 2017), http://www.politico.com/tipsheets/politico-
pulse/2017/01/trumps-travel-ban-rattles-medical-residency-programs-218499.
58
Shashank Bengali et al., Families hoping to make the U.S. their home scramble to rearrange
their lives, L.A. Times (Jan. 27, 2017), http://www.latimes.com/world/la-fg-refugees-order-
reaction-20170127-story.html.
59
See id.
60
Brie Zeltner, Trump Order Complicates Match Day for Northeast Ohio Hospitals, Cleveland
Plain Dealer (Feb. 3, 2017),
http://www.cleveland.com/healthfit/index.ssf/2017/02/trump_immigration_order_compli.html.
61
Maria C. Savoia and Mona M. Signer, Statement on the Executive Order Suspending Entry
into the United States, National Resident Matching Program (last accessed Feb. 12, 2017),
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from over one hundred countries come to the United States to participate in conferences, deliver
patient care, conduct research, participate in medical education and engage in scientific
discourse.62 Such exchanges and meetings advance the state of patient care in the United States
But days after the Executive Order was issued, over 6,300 scientists, including medical
professionals, vowed to boycott conferences hosted in the United States, pledging not to attend
international conferences in the US while the ban persists.63 Certain organizations that host
important medical conferences, such as the Genetics Society of America (GSA), have already
received cancellations from colleagues born in the seven Muslim-majority countries who are not
permitted to enter the United States per the Order.64 According to GSA, others have decided not
to travel to the United States in protest of the new restrictions.65 The International Society for
Autism Research deeply troubled by the Executive Order announced that we must think
http://www.nrmp.org/wp-content/uploads/2017/02/NRMP-Statement-on-Immigration-Executive-
Order.pdf.
62
CMSS Position on International Collaboration in Medicine, Council of Medical Specialty
Societies (Feb. 3, 2017), https://cmss.org/new/cmss-position-on-international-collaboration-in-
medicine/.
63
Ivan Oransky and Adam Marcus, Scientists protest immigration ban with boycotts of journals,
conferences, Stat (Feb. 1, 2017), https://www.statnews.com/2017/02/01/scientists-protest-
immigration-ban/. Link to the petition is available at
https://docs.google.com/forms/d/e/1FAIpQLSeNN_2HHREt1h-
dm_CgWpFHw8NDPGLCkOwB4lLRFtKFJqI25w/viewform.
64
Statement from GSAs Executive Committee on the U.S. Presidents Executive Order on
Immigration, Genetics Society of America (Feb. 3, 2017), https://genestogenomes.org/statement-
from-gsas-executive-committee-on-the-u-s-presidents-executive-order-on-immigration/.
65
Id.
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carefully about whether to host future international meetings for autism research in the United
States. As an international society, it would be inappropriate to hold the largest annual meeting
on autism research in any country that restricts access to our colleagues worldwide.66
Another harmful effect on scientific collaboration will arise as holders of J-1 or H-1B
visas decide not to attend international conferences for fear of not being allowed to return to the
United States. For example, an Iranian molecular geneticist finishing a postdoctoral program at
Harvard Medical School and Massachusetts General Hospital, recently expressed concern that, in
speaking at a molecular biology meeting next month in Banff, Canada, he risks being stranded in
As the AAMC, the umbrella organization for U.S. medical schools and teaching
hospitals, has stated: because disease knows no geographic boundaries, it is essential to ensure
that we continue to foster, rather than impede, scientific cooperation with physicians and
researchers of all nationalities, as we strive to keep our country healthy.68 The Executive Order
Finally, the Executive Order hinders the ability of medical organizations to provide care
for foreign nationals, particularly those from war-torn areas. Without regard to national
66
Geraldine Dawson, Message from the INSAR President, International Society for Autism
Research (Feb. 1, 2017), http://www.autism-insar.org/president-message.
67
Lauren Morello and Sara Reardon, Meet the scientists affected by Trumps immigration ban,
Nature (Jan. 29, 2017), http://www.nature.com/news/meet-the-scientists-affected-by-trump-s-
immigration-ban-1.21389.
68
AAMC Statement on President Trumps Executive Order on Immigration, Association of
American Medical Colleges (Jan. 30, 2017), https://news.aamc.org/press-
releases/article/executive-order-immigration-013017/; see also Armstrong, et al, International
Exchange and American Medicine, New England J. Med. (Feb. 1, 2017),
http://www.nejm.org/doi/pdf/10.1056/NEJMp1701339 (noting that medical exchange occurs
across geographic boundaries, and stating that it is well known that a large proportion of the
most talented and productive research trainees come from abroad.).
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boundaries, the Hippocratic Oath counsels that doctors have special obligations to all [their]
fellow human beings, those sound of mind and body as well as the infirm.69 Following the
inclusive spirit of the Oath, United States hospitals routinely engage in borderless healthcare by
treating foreign nationals who cannot obtain necessary medical care in their countries. In
arrangements like these, hospitals sometimes provide their services pro bono.
Several of the nations leading medical centers have already identified more than three-
dozen patients from the seven affected countries who were scheduled to come to the United
States to receive medical care, but whose travel was delayed or postponed by the Executive
One of the most high-profile cases where the Executive Order impacted humanitarian
medical care is that of Fatemah Reshad, a four-month-old Iranian infant diagnosed with a serious
heart defect that doctors in her own country lacked the resources to treat.72 Fatemah was
traveling with her parents to meet her uncle in Portland, Oregon, where doctors were waiting to
evaluate her for surgery on February 5, 2017. As a result of the Executive Order, the family was
rerouted back to Iran and told to reapply for United States visas in 90 days, despite Fatemahs
immediate need for surgery. Subsequently, Fatemah has been cleared to re-enter the United
States to receive the life-saving surgery she needs, but only after state and federal officials
69
Louis Lasagna, Hippocratic Oath - Modern Version (1964).
70
Dylan Scott and Megan Thielking, After Trump Order, Hospitals Scramble To Aid Patients
Planning To Travel To US for Care, Stat (Jan. 30 2017),
https://www.statnews.com/2017/01/30/trump-immigration-order-hospitals/.
71
Id.
72
Azadeh Ansari and Marlena Baldacci, Iranian Baby Girl Caught in Trump Travel Ban Headed
to US, Governor Says, CNN (Feb. 4, 2017), http://www.cnn.com/2017/02/03/politics/travel-ban-
iranian-baby-heart-surgery-trnd/.
73
Id.
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The Executive Order has interfered with the medical treatment of others as well.
According to a lawyer from the Center for Victims of Torture, at least twenty refugees from
Syria and Iraq with serious medical conditions are attempting to come to the United States for
medical treatment, 74 but are banned under the terms of the Executive Order. They include
Mustafa, a Syrian 17-year-old boy who lost part of his jaw and facial bone in a mortar attack on
his home when he was 13, and who was scheduled for reconstructive surgery at Shriners
Hospital in Galveston, Texas in April.75 The Executive Order curtailed his travel plans and it is
presently unclear whether he will be able to return to the United States before he turns 18, the
typical age limit to receive free care from the Shriners Hospital.76 Other similarly affected
Syrian children who were planning to receive domestic medical care include Mohammed, a 6-
year-old scheduled to receive cancer treatments for Ewing sarcoma and Hamzi and Jinan, 14-
The medical outcomes of the desperate and tragic plights of these children and their
families have yet to be learned. But it is safe to observe that, but for the numerous courts who
issued partial or complete stays of the implementation of the Executive Order and the outcry of
many concerning the ban, these children would have lost all hope of receiving critical medical
CONCLUSION
Although some of the harm to the public interest is long term, much of the harm is
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would clear the way for the immediate provision of health care by, and medical collaboration
with, medical personnel who are barred from entering the United States because they are from
one of the seven countries identified in the Order. Similarly, an injunction would block the denial
of visa renewals for physicians from the targeted nations who are already in the United States
and providing care to their respective communities. Additionally, as described above, the Order
directly interferes with the Match program, which is actively ongoing and has key deadlines over
the next few weeks. For these and other foregoing reasons, the Court should find that an
injunction of the Executive Order would benefit the public interest and, on the collective
submissions of the plaintiffs and aligned amici, grant the declaratory and injunctive relief
requested by plaintiffs.
21