The number of people receiving treatment at the National Institutes of Health Clinical Center — the renowned research hospital that cares for patients with rare or life-threatening diseases — has tumbled under the second Trump administration, according to government documents and interviews with current and former NIH employees.
NIH documents viewed by KFF Health News show a pronounced decline in patients at the 200-bed hospital from February through April, a time that coincides with the Department of Health and Human Services’ mass firings of government employees, the gutting of scientific research, and the administration’s broad crackdown on immigration. The average number of patients being treated daily during that time hovered between 60 and 80, with the April numbers falling to the lower end of that range. By contrast, in October, about 80 patients a day on average were at the hospital.
The number of cancer clinical trial participants at the hospital as of July was down about 20% from last year, one NIH cancer scientist said. KFF Health News agreed not to identify the scientist and others who participated in this article who were not authorized to speak to the press and feared retaliation.
The numbers “really don’t look too good,” Pius Aiyelawo, acting CEO of the clinical center, said during a May 23 meeting of the NIH Clinical Center Research Hospital Board.
As of April 30, the average number of patients in the hospital per day had declined by 5.7% from the same period a year ago.
Adults and children with cancer, people who need bone marrow transplants, and people with rare diseases or infections are among the patients who receive care at no charge at the NIH hospital, according to former officials. Clinicians there provide potentially lifesaving treatments as part of clinical trials, often to people who have run out of options.
Research at the hospital has also led to breakthroughs about cancer, traumatic brain injury, and AIDS, among other ailments. James Gilman, a physician who was CEO of the clinical center from 2017 until retiring in January, said the center has driven important advances against disease “that couldn’t have happened anywhere else.”
Former officials said the drop in patients this year is a consequence of the upheaval the Trump administration has caused at the NIH, the world’s largest public funder of scientific research.
Current and former employees say an exodus of clinicians, scientists, and other staffers has limited how many patients can be treated. Morale has tanked because of widespread firings and the administration’s cancellation of grants that funded research into health disparities, vaccines, the health of LGBTQ+ people, and more. Contracts have been cut, and scientists have seen delays in getting essential supplies for clinical research.
“Every day seems to be some type of breaking point,” one NIH worker said.
During the May board meeting, a video of which KFF Health News viewed, Aiyelawo attributed the decrease in patients coming to the hospital to the departure of NIH investigators — the researchers on studies — and less patient recruitment. He also noted 11 recent departures of clinical center staffers. They included Christine Grady, a nurse who led the center’s bioethics department and the wife of Anthony Fauci, the former head of the NIH’s infectious diseases institute who became a lightning rod for conservatives during the covid pandemic.
HHS has fired more than 1,200 NIH employees this year as part of its purge of the federal workforce, but the true number of departures is almost certainly higher. Others have opted for early retirement or quit because they opposed the Trump administration’s orders.
Gilman said the NIH hospital relies on a “very complex ecosystem and network to find patients who are not too sick” to potentially be enrolled in a clinical trial. When researchers leave, “those patients are lost,” he said.
The clinical center’s 2025 annual report said there were roughly 1,500 research studies underway in 2024, including studies focused on cancer, infectious disease, heart and lung conditions, and blood disorders. Clinical trials accounted for about half.
The National Cancer Institute — which is the largest of the NIH’s 27 institutes and has been crippled by cuts and chaos this year — typically has the most patients needing inpatient care, Gilman said.
“What has happened here since January has been a pretty traumatic time for that ecosystem,” he said, “and there are pieces of it that will take a long time to rebuild, if indeed they get a chance to rebuild.”
During the May board meeting, Aiyelawo said NIH Director Jay Bhattacharya “is very aware” that fewer people are getting treated at the hospital “and we’re doing everything we can to be able to get those numbers up.”
The drop in patients this year isn’t isolated to people needing inpatient care, NIH documents show. As of the end of April, outpatient visits were down 8.5% from the same period in the prior fiscal year. The number of new patients overall had declined by 6.7%, to about 3,370 people.
In response to questions, HHS spokesperson Andrew Nixon wrote in an emailed statement that the clinical center “remains fully operational and continues to provide world-class clinical research and patient care. Every day, patients from across the country and around the globe come here to participate in cutting-edge studies that drive scientific discovery and improve health outcomes.”
“As the crown jewel of research and discovery, the Clinical Center is a top priority” under Bhattacharya’s leadership, Nixon said. “We are committed to fully leveraging its capabilities as the nation’s hub for clinical research innovation. Our focus remains on empowering the research community and advancing the critical mission of making medical breakthroughs possible right here on the NIH campus.”
Even before President Donald Trump began his second term, the hospital had struggled with lagging patient numbers. Before the pandemic, it averaged more than 110 patients daily. Those numbers plummeted starting in 2020, government documents show. During the 2022 fiscal year, there were about 73 patients, on average, in the hospital per day.
While yearly figures have increased since then, they have not gone back to pre-pandemic levels. NIH documents show that the hospital saw an average of roughly 81 patients a day during fiscal 2024, which ended in September. Still, one NIH worker said: “This is a manufactured crisis. Covid was not.”
The federal government has also moved to tighten rules surrounding visitors from abroad, which likely limits how many people living in the U.S. without legal status would come to the NIH for care.
Before Trump, officials developed a new visitor policy for the NIH that required people who aren’t U.S. citizens or legal permanent residents to register online before arriving. But its implementation was delayed, Gilman said. It did not launch until late January, after President Joe Biden was no longer in office and around the time the Trump administration began its deportation operation.
The Department of Homeland Security has carried out widespread raids and arrests and allowed immigration authorities unprecedented access to various federal data sources — including tax information and Medicaid recipients’ personal data — as part of its immigration enforcement efforts.
The clinical center’s most recent annual report said around 600 patients in 2024 were from abroad.
Now “international patients are terrified to come,” said one recently departed clinician. “They don’t know what will happen to them.”
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