EXECUTIVE SUMMARY
A patient who presented with a suspicious driver’s license was arrested after Memorial Hermann Hospital’s clinic staff called law enforcement, which led to protests by immigration rights groups and an investigation by the Department of Health & Human Services’ Office for Civil Rights.
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Do nothing to impede treatment of emergency department patients.
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Inform the compliance department, to ensure that medical records do not get combined.
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Contact the billing department, so claims are put on hold.
Recently, a patient was arrested after clinic staff at Houston, TX-based Memorial Hermann Hospital called local law enforcement because she allegedly presented with a suspicious driver’s license. The incident led to protests by immigration rights groups and triggered an investigation by the Department of Health & Human Services’ Office for Civil Rights.
In a statement, the hospital said, “For quality and safety reasons, our staff requests and verifies proper identification to ensure appropriate treatment. The patient was unable to provide another valid form of identification and in an effort to verify the authenticity of the suspicious driver’s license, the office then called the licensing bureau of the Texas Department of Public Safety (DPS). DPS instructed our staff to contact local law enforcement to validate the driver’s license number. This inquiry confirmed a false identification. Local law enforcement took this information and made the decision to arrest the patient.”
All patient access areas need to be prepared for how to handle suspicious ID, emphasizes Nancy Farrington, CHAM, FHAM, Enterprise Master Patient Index administrator at Main Line Health in Wynnewood, PA.
“It is not fair to staff to be confronted with such a troubling situation for which they have not been given guidance,” she says. Farrington recommends these approaches:
• If the patient is in the emergency department, staff members should not do anything to impede treatment.
“However, they should alert the care providers of their suspicion,” says Farrington. If it’s a different patient, then any medical history the hospital has for the patient on the ID might be incorrect for the patient being treated. “Additionally, sometimes based on clinical data, such as anomalies seen on images or implanted devices, care providers can determine if it is the same patient or not,” she adds.
• Involve security or police only if patient access staff members are concerned about their physical safety.
“Doing that opens the provider to charges or accusations of HIPAA [Health Insurance Portability and Accountability Act] violations,” says Farrington.
However, patients seeking medication, or needing treatment related to drugs and alcohol, sometimes present with false or stolen ID and become belligerent when questioned. “When that happens, involving security is important,” says Farrington.
• Involve a social worker if possible.
“Typically, social workers are better trained than registration staff to de-escalate the situation, avoiding the need for police involvement,” says Farrington.
BALANCING ACT
Compliance with the Emergency Medical Treatment and Labor Act (EMTALA) is a concern whenever patients present with suspicious ID, says Aimee Egesdal, manager of patient access at Genesis Health System in Davenport, IA.
“We have to balance taking care of the patient medically prior to approaching the issue of possible false ID,” she explains.
At Genesis Health System, the following steps occur:
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Patient access staff members report the concern to the ED charge nurse.
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2The ED charge nurse contacts security staff and possibly outside authorities.
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Patient access staff members inform the hospital’s compliance department to ensure that medical records do not get combined.
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Patient access leaders contact the billing department so claims are put on hold until the patient’s identity is verified.
Often, the identification appears valid, but the patient stumbles when answering basic demographic questions.
“It is a fine line on when we can confront the patient,” says Egesdal. “It takes registration, ED clinical staff, and security working very closely with each other.”
Registrars can’t always tell the difference between a patient who is confused due to a medical problem and a patient who is purposely giving incorrect information. “That is the main reason we escalate to the charge nurse,” says Egesdal. “They can use their clinical expertise to make the call to security or chalk it up to confusion.”
If the patient is seeking non-emergent care, the provider can choose to treat the patient or not, says Farrington.
“There is no national standard on how to respond,” she explains.
If the provider is going to treat the patient, he or she should seek additional verifying information, such as recent utility bills or pay stubs with the patient’s address. “It is important that the provider have a means of contacting the patient once they have left the facility,” Farrington emphasizes. Providers might need to contact the patient about follow-up care or to share test results.
“If the provider chooses to not treat the patient, they should offer a future appointment when the patient can present documentation to validate their identity and potentially make payment arrangements,” says Farrington.
SOURCES
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Aimee Egesdal, Manager, Patient Access, Genesis Health System, Davenport, IA. Email: [email protected].
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Nancy Farrington, CHAM, FHAM, Health Information Management, Main Line Health, Wynnewood, PA. Email: [email protected].
