Paige Adamson, 61, was a Canadian citizen and a lawful permanent resident of the United States. The Whatcom County medical examiner’s office said she died of blood loss anemia after fracturing her right femur in a fall.

Her son, Dylan Adamson, and immigration lawyer Len Saunders said she had been feeling unwell and wanted to see a doctor in Bellingham, but feared she might be detained if she tried to leave Point Roberts. The small U.S. community sits south of British Columbia and is separated from the rest of Washington by Canadian territory; reaching Bellingham by car requires crossing the border twice.

Adamson had traveled to Canada on Sept. 15 to celebrate her birthday with friends. Saunders said she was questioned for about six hours when she returned to the United States, then released with notice to appear in immigration court Nov. 4. Department of Homeland Security documents allege she improperly registered to vote and voted in 2018.

Saunders said Adamson told him she could not afford to fly or take a boat to Bellingham. He described her as feeling forced to choose between staying in Point Roberts while unwell and risking detention. Two days before her death, he said, she told him she had been “stuck” there for a month.

Dylan Adamson said his mother had recently been injured in a fall and that he is left wondering whether a misunderstanding about her voting history contributed to her inability to get care. He said she had touched many lives in Point Roberts and questioned why a longtime neighbor would face the prospect of detention while trying to travel within the region.

U.S. Customs and Border Protection said a noncitizen found to have voted in a federal election may be refused admission or detained while removal proceedings are pending. The agency said noncitizens who register to vote or vote in a federal election may be denied entry or removed under the Immigration and Nationality Act.

Washington law makes it a felony to knowingly register to vote when ineligible. State law does not make it a crime to register unknowingly; people who make an honest mistake must deregister and have their voting record cleared, according to the statutes cited by state officials.

Immigration lawyers say lawful permanent residents can mistakenly register to vote, including through errors during driver’s license applications or interactions with canvassers. Seattle immigration lawyer Vicky Dobrin said the people involved in such cases may not have knowingly done anything wrong. Lawyers have also reported federal immigration agents visiting homes to ask residents about their voting status.

The case comes amid increased federal scrutiny of alleged voter fraud. A California judge recently barred federal agents from visiting homes in nine states to question people about their voting status ahead of the Nov. 3 midterm elections, citing concerns that the government was relying on flawed and outdated data that had targeted U.S. citizens.

For residents of Point Roberts, the case underscores the consequences that immigration proceedings can have on routine travel and access to services on the mainland. Adamson leaves behind two sons.