The “Secret Patient” arrived at your hospital in a proper EMTALA transfer from Hospital A. They sent all required information but the patient’s name or ANYOTHER identifying information — he and supposed family member REFUSED to disclose it. Your hospital hospital provides appropriate screening, admits the patient, provides surgery, and provides appropriate after care to the tune of $60,000 — but at no time would the SECRET PATIENT give name address, phone, ssn, or any other element of identification during the entire process, and none of the efforts of your hospital yielded any identifying information prior to discharge.
Your thoughts and comments are welcome in the comments section below.
You just provided good care with no method to obtain payment for your services, unless your state has charity care and you have documentation as to attempts to obtain the needed information.
Treat the patient as always, same as you would do under same or similar circumstances for any other patient. Once stabilized, discharge with a “family member” with appropriate and specific written instructions. The hospital writes the care off as an “administrative guest.” Hopefully the physicians are hospital employed and get paid no matter what (;-D)
As long as pt properly identified with at least 2 independant identifiers that could be appropriately followed thru hospital’s system linking all data together, and pt abundantly aware that he would be responsible for accumulated bill, although i am not certain how to make him pay it or find him for payment later!! however, i feel obligated to treat and if he does not pay, what is a system to do?
Interesting story and I assume the patient did not have two identifiers as he refused to give any info? I would have backed up and put the burden on the sending hospital. You have to have an accepting physician and an accepting hospital. Both should have insisted they cannot accept a patient they don’t even know that exists! They would have been correct in asking for prior medical records, etc. before the transfer.
Treating the patient, giving the instructions, sending home and then writing it off would be a terrible precedent to set especially if it hit the news…
Very practical answer, but they would be dangerously close to violating EMTALA — which is one of the points I wanted to make in this. MAJOR REMINDER: Under EMTALA, you cannot put ANY conditions on accepting a transfer. You can ask for whatever you think is appropriate (except financial information prior to accepting the patient) but you cannot condition your acceptance of an EMTALA transfer on things you might consider relevant, such as two identifiers — that is what a John Doe protocol is about. You can ask for medical records from the current visit (required under EMTALA), but you cannot require the sending facility provide an ID if they don’t have one. If you think the sending facility is not playing fair, you can always report them, but you still have to take the patient on a declared EMTALA transfer subject to the capability and capacity limitations.