Claire Dawson
John Does are patients who arrive at hospitals with no identification, and no materials on them that could help staff identify them. Hospitals need to identify these patients to avoid the treatment risks that come with not knowing a patient's medical history, to find next of kin to help make medical decisions, and to collect payment from insurance companies or government health programs. However, federal privacy laws can make uncovering a patient's identity challenging for hospitals.
| Characteristics | Values |
|---|---|
| Number of unidentified patients | A large public hospital in Los Angeles gets over 1,000 unidentified patients a year |
| Identification of patients | Hospitals play detective to identify patients by checking their belongings, contacting the paramedics and dispatchers, looking for distinguishing features, and checking dental records |
| Privacy laws | Federal privacy laws, such as HIPAA, restrict hospitals from releasing information about unidentified patients, even to missing persons inquiries |
| Guidelines for cognitively incapacitated patients | California guidelines allow hospitals to disclose limited information to locate a patient's next of kin if it is in the patient's best interest |
| Challenges in identification | Unidentified patients may have no belongings, distinguishing features, or contacts, making identification difficult |
| Success rate | Most John Does are quickly identified, but some remain unidentified and may die or be transferred to nursing homes with made-up names |
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What You'll Learn
Hospitals play detective to identify John Does
Hospitals are often faced with the challenge of identifying John Does, or patients who arrive at the emergency department without any identification. This can be a complex and time-consuming process, requiring hospital staff to play detective and piece together clues to establish the patient's identity.
The pressure of identifying unknown patients is widely felt by emergency response staff due to inadequate patient matching systems. In the United States, a large public hospital in Los Angeles, LA County+USC Medical Center, receives over 1,000 unidentified patients each year. While most are quickly identified, some require extensive investigative work, complicated by federal privacy laws and medical privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA).
To identify John Does, hospital staff, particularly social workers, must employ creative and thorough methods. They start by searching the patient's belongings, including bags, clothing, and pockets, for any form of identification, such as an ID card, wallet, or cellphone. They also look for clues such as receipts, scraps of paper, or even a bank card, which might provide a name or other relevant information. If the patient has an unlocked phone, they may search the contacts for potential family members or friends.
In addition to searching the patient's belongings, hospital staff interview the paramedics and dispatchers involved in the case. They take note of any distinguishing features, such as tattoos, piercings, or scars, and may even try to locate dental records or fingerprints, although the latter often requires involvement from law enforcement. Social media can also be a useful tool in identifying John Does, as hospital staff can attempt to cross-reference tattoos, scars, or other unique characteristics with online profiles.
In cases where the patient remains unidentified for an extended period, temporary aliases are assigned, typically using the patient's gender, followed by a number and a random name. These measures are essential not only for making informed medical decisions based on the patient's history but also for locating next of kin to involve them in treatment decisions and payment processes.
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Privacy laws make identification challenging
Privacy laws make identifying John Does challenging for hospital staff. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) ensures the privacy of an individual's medical data. While this is important for patient privacy, it can make patient matching difficult. Hospitals cannot release any information to those searching for missing family members regarding unidentified patients. For example, a patient with Alzheimer's was admitted to a New York hospital as "Trauma XXX". The police and his family members searched for him at the hospital several times, but the hospital was unable to disclose any information.
In California, guidelines stipulate that if a patient is unidentified and cognitively incapacitated, "the hospital may disclose only the minimum necessary information that is directly relevant to locating a patient's next-of-kin, if doing so is in the best interest of the patient". Hospitals are bound by privacy laws that require them to protect patient information and prevent unauthorised access or disclosure. This can make it difficult for hospital staff to identify John Does, even when their family members are actively searching for them.
To identify patients, social workers at hospitals might look through their bags, clothing, and cell phones for any clues about their identity. They might also check for distinguishing features such as tattoos or scars and try to cross-reference with social media. When a patient remains unidentified for a certain amount of time, they may be given an alias. This process can be challenging and time-consuming, and it may result in patients remaining unidentified during their stay at the hospital.
Privacy laws, such as the Privacy Act of 1974, require agencies to give notice of their systems of records and prohibit the disclosure of records about an individual without their consent or a statutory exception. These laws protect individuals' privacy and ensure that their personal information is not shared without their permission. While this is important for maintaining privacy and security, it can make identifying John Does in hospitals more difficult.
In addition to federal privacy laws, hospitals must also navigate state guidelines and laws regarding unidentified patients. Some states have established guidelines to help hospitals with unidentified patients cooperate with missing person inquiries. For example, after the incident in New York mentioned above, the New York State Missing Persons Clearinghouse released guidelines outlining steps hospitals can take when receiving inquiries about missing persons. These varying laws and guidelines can add complexity to the process of identifying John Does.
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Hospitals need names for insurance/government payments
Hospitals need to identify patients for several reasons, including the need to know their medical history to provide appropriate treatment and to locate their next of kin to make medical decisions. Another critical reason is to obtain a name for insurance and government payment purposes.
When a patient is admitted to a hospital without identification, they are often given a temporary name, such as "John Doe" or "Trauma XXX," until their identity can be established. This process of identifying these patients can be challenging and time-consuming for hospital staff due to federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA), which protect an individual's medical data. Hospitals must navigate these privacy laws while trying to uncover a patient's identity.
In the case of John Does, hospital staff must play detective, searching through personal belongings, checking distinguishing features like tattoos or scars, and even consulting with local authorities to match fingerprints or dental records. They also question paramedics and dispatchers, and consult social workers to gather any information that might help identify the patient. This process is crucial because, without a name, hospitals cannot collect payment from private insurance companies or government health programs like Medicaid or Medicare.
The pressure on hospital staff to identify these patients is significant. A public hospital in Los Angeles, for example, receives over 1,000 unidentified patients annually. While most are quickly identified, some remain unknown and are transferred to nursing homes with made-up names. This challenge highlights the need for improved patient matching systems that can help identify patients and ensure proper payment procedures.
To conclude, hospitals' need for patient identification goes beyond medical treatment and next-of-kin decisions. It extends to financial matters, including insurance and government payments. The challenges faced by hospitals in identifying John Does underscore the importance of developing more efficient patient matching systems while adhering to privacy laws.
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Hospitals try to locate next of kin
Hospitals face a challenging task when it comes to identifying John Doe patients and locating their next of kin. In the case of a 50-year-old man with a shaved head and brown eyes, who was unresponsive when brought into the emergency room, hospital staff had to go beyond checking his pockets for identification. They had to play detective, searching for any distinguishing features like tattoos or scars and even checking dental records. Social workers also examined his belongings, including his phone, receipts, and other personal items, for clues about his identity.
Federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA), further complicate the process of identifying John Does. Hospitals must balance patient privacy with the urgent need to locate next of kin, especially when the patient is cognitively incapacitated. In such cases, hospitals are permitted to disclose limited information relevant to finding the patient's next of kin if it is in the patient's best interest. This delicate balance between privacy and the need for information can lead to challenges and delays in identifying John Does and locating their families.
To overcome these challenges, hospital staff employ various strategies. They may contact local homeless services, reach out to police stations, or check with missing persons reports. They also look for clues that could indicate the patient's residence, such as addresses or items found on their person. Additionally, hospitals may provide the patient with an alias if they remain unidentified for an extended period.
Despite their best efforts, hospitals do not always succeed in identifying John Does. From 2016 to 2018, for example, ten individuals at LA County+USC remained unidentified during their stays, some of whom passed away without their identities being discovered. However, hospitals continue to pursue all avenues in their quest to identify these patients and locate their next of kin.
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John Does are often unidentified for long periods
There are various reasons why John Does may go unidentified for extended periods. One significant factor is the lack of identifying information or possessions on their person when they arrive at the hospital. This absence of personal items can hinder the ability of hospital staff to determine their identities through traditional methods, such as searching through their belongings or cross-referencing with social media. Additionally, patients with cognitive impairments, such as Alzheimer's disease, or those in a psychotic state, may be unable to provide any information themselves, prolonging the identification process.
The identification of John Does is further complicated by federal privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA), which protects an individual's medical data. While these laws are essential for safeguarding patient privacy, they can make it challenging for hospitals to release information to individuals searching for missing family members. This delicate balance between patient privacy and the need for identification can lead to situations where even family members or the police are unable to obtain information about a John Doe, as illustrated by the case of a man with Alzheimer's admitted to a New York hospital under the name "Trauma XXX."
To address the challenge of identifying John Does, hospital staff members often have to adopt the role of detectives. They meticulously search through patients' belongings, including bags, clothing, and cell phones, for any clues that could help establish their identities. They also look for distinguishing features, such as tattoos, scars, or piercings, and may even attempt to access dental records or fingerprints, although the latter often requires involvement from law enforcement. Social workers play a crucial role in this process, sometimes going beyond the hospital walls to connect with local communities, homeless services, or family members to gather information and piece together the identities of these unknown individuals.
The consequences of prolonged unidentified status can be significant. John Does may pass away in the hospital without their loved ones ever knowing their fate. Others may be transferred to nursing homes with made-up names, never regaining their true identities. Additionally, establishing a patient's identity is crucial for making informed medical decisions, as it provides access to their medical history. It also enables hospitals to locate next-of-kin or surrogate decision-makers, ensuring that someone can advocate for the patient's best interests.
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Frequently asked questions
A John Doe is a patient who arrives at a hospital and cannot be identified.
Hospitals try to identify John Does by searching their belongings for clues, checking for distinguishing features such as tattoos and scars, and questioning paramedics and dispatchers. They also try to match dental records and fingerprints, though this requires police involvement. Social workers may also get in touch with case workers at homeless services if they suspect the patient is homeless.
Establishing a patient's identity helps hospitals avoid treatment risks that come with not knowing a patient's medical history. It also helps hospitals find next of kin to make medical decisions and collect payment from insurance or government health programs.
Federal privacy laws, such as HIPAA, make it difficult for hospitals to disclose patient information. Hospitals can only disclose the minimum necessary information to locate a patient's next of kin if the patient is cognitively incapacitated and it is in their best interest.
