'John Doe' Patients Sometimes Force Hospital Staff To experience Detective

The 50-something man with a shaved head and brown eyes was unresponsive once the paramedics wheeled him into the er. His pockets were empty: no wallet, no cellphone, not a single scrap of paper that may reveal his identity towards the nurses and doctors trying to save his life. His body lacked any distinguishing scars or tattoos.

Almost 2 yrs after he was hit with a car on busy Santa Monica Boulevard in January 2021 and transported to Los Angeles County+USC Medical Center having a devastating injury to the brain, nobody had come looking for him or reported him missing. The person died within the hospital, still a Someone in particular.

Hospital staffs sometimes must play detective when an unidentified patient arrives for care. Establishing identity helps steer clear of the treatment risks that come with not knowing a patient's medical history. Plus they make an effort to find next of kin to help make medical decisions.

“We’re looking for a surrogate decision-maker, a person who might help us,” said Jan Crary, supervising clinical social worker at L.A. County+USC, whose team is frequently called on to identify unidentified patients.

The hospital also requires a name to gather payment from private insurance or government health programs for example Medicaid or Medicare.

But federal privacy laws can make uncovering a patient's identity challenging for personnel at hospitals nationwide.

At L.A. County+USC, social workers pick through personal bags and clothing, scroll through cellphones that are not password-protected for names and amounts of friends or family, and scour receipts or crumpled bits of paper for any trace of a patient’s identity. They quiz the paramedics who introduced the patient or the dispatchers who took the phone call.

They also make note of any tattoos and piercings, and even attempt to track down dental records. It's more difficult to check fingerprints, because that's done through law enforcement, that will become involved only when the situation includes a criminal aspect, Crary said.

Unidentified patients are often pedestrians or cyclists who left their IDs at home and were struck by vehicles, said Crary. They may also be people with severe cognitive impairment, such as Alzheimer's, patients inside a psychotic state or drug users who've overdosed. The hardest patients to identify are ones who are socially isolated, including homeless people – whose admissions to hospitals have become sharply recently.

In the past 3 years, the number of patients who arrived unidentified at L.A. County+USC ticked up from 1,131 in 2021 to 1,176 in 2021, according to data provided by a healthcare facility.

If a patient remains unidentified for too long, the staff at the hospital can make up an ID, usually starting with the letter “M” or “F” for gender, followed by several along with a random name, Crary said.

Jan Crary, supervising clinical social worker at Los Angeles County+USC Medical Center, leads a group who increasingly must play detective when patients cannot be identified.((Heidi de Marco/KHN))

Other hospitals turn to similar tactics to help ease billing and treatment. In Nevada, hospitals have an electronic system that assigns unidentified patients a “trauma alias,” said Christopher Lake, executive director of community resilience in the Nevada Hospital Association.

The deadly mass shooting in a Vegas concert in October 2021 presented a challenge for local hospitals who sought to recognize the sufferers. Most concertgoers were wearing wristbands with scannable chips that contained their names and charge card numbers so that they could buy beer and souvenirs. Around the nights the shooting, the final day of a three-day event, many patrons were so comfortable with the wristbands they carried no wallets or purses.

More than 800 people were injured that night and rushed to numerous hospitals, none of which were equipped with the devices to scan the wristbands. Staff at the hospitals worked to identify patients by their tattoos, scars or any other distinguishing features, as well as photographs on social media, said Lake. However it was a struggle, especially for smaller hospitals, he explained.

The Health Insurance Portability and Accountability Act (HIPAA), a federal law intended to make sure the privacy of private medical data, can sometimes make an identification more arduous just because a hospital may not want to release info on unidentified patients to individuals inquiring about missing persons.

In 2021, a guy with Alzheimer’s disease was admitted to a different York hospital through the emergency department as an unidentified patient and assigned the name “Trauma XXX.”

Police and family members asked about him at the hospital several times but were told he wasn't there. Following a week – where countless friends, family members and police searched for the man – a doctor who worked in the hospital saw a news story about him on television and realized he was the unidentified patient.

Hospital officials later told the man's son that because he hadn't explicitly asked for “Trauma XXX,” they couldn't provide him information that may have helped him identify his father.

Prompted with that mix-up, the brand new York State Missing Persons Clearinghouse drafted a set of guidelines for hospital administrators who receive information requests about missing persons from police or members of the family. The rules include about 24 steps for hospitals to follow along with, including notifying the leading desk, entering detailed physical descriptions into a database, taking DNA samples and monitoring emails and faxes about missing persons.

California guidelines stipulate that if a patient is unidentified and cognitively incapacitated, “the hospital may disclose just the minimum information you need that is directly relevant to locating a patient's next-of-kin, if doing so is incorporated in the best interest of the patient.”

At L.A. County+USC, most John Does are quickly identified: They either regain consciousness or, as in most cases, friends or relatives call asking about them, Crary said.

Still, a healthcare facility does not always succeed. From 2021 to 2021, 10 John and Jane Does remained unidentified during their stays at L.A. County+USC. Some died at the hospital; others went to nursing facilities with made-up names.

But Crary said she and her team pursue every avenue looking for a name.

Once, an unidentified and distinguished-looking older man with a neatly trimmed beard was rushed in to the er, delirious with what was later diagnosed as encephalitis and unable to speak.

Acting on a gut instinct the well-groomed man must have a loved one who had reported him missing, Crary checked with police stations in the area. She learned instead this John Doe was wanted in a number of states for sexual assault.

“He was done in with a mosquito,” Crary mused.

“It is a case that I won't ever forget,” she added. “The fact is that I am more elated if we are in a position to identify a patient and look for family for any beautiful reunification instead of finding a felon.”