Asked about citizenship during triage

Nurses General Nursing

Published

A friend went to the ER, and while being triaged he was asked if he was a US citizen ( this was in the USA of course). Is this customary? I never recalled being asked when I was a patient, nor do I recall asking when I was a nurse. Is this the new normal?

Specializes in Critical Care.
Definitely NOT. They should not be asking this question, and this needs to be reported. There are nurses turning in patients to ICE, which is reprehensible. Administration needs to be notified, and if they are aware that this is going on, they need to come up with a plausible answer as to why. Hint, there isn't one. This is raw meat for the ACLU.

The reimbursement that goes along with treating undocumented immigrants, and results in patients being asked about their immigration status, has been around for 13 years, and yet the ACLU hasn't been interested and I'm not sure why they would be.

Aside from HIPAA, which prohibits hospital staff from notifying any law enforcement agency that someone is a patient at your facility except in the case of an imminent threat to others, there is also the regulatory standards of physicians and nurses that prevents reporting patients to ICE. I can find no examples of nurses reporting patients to ICE, the only reported instance of a hospital reporting someone to ICE was when a hospital employee was using a fraudulent SS number.

The reimbursement that goes along with treating undocumented immigrants, and results in patients being asked about their immigration status, has been around for 13 years, and yet the ACLU hasn't been interested and I'm not sure why they would be.

Aside from HIPAA, which prohibits hospital staff from notifying any law enforcement agency that someone is a patient at your facility except in the case of an imminent threat to others, there is also the regulatory standards of physicians and nurses that prevents reporting patients to ICE. I can find no examples of nurses reporting patients to ICE, the only reported instance of a hospital reporting someone to ICE was when a hospital employee was using a fraudulent SS number.

Border Patrol Arrests Near Safe Zones Worry Immigrant Advocates : NPR

And no, pt's are not asked about their immigration status; they are asked about insurance.

Specializes in Critical Care.

That's loosely related to your statement that nurse's are calling ICE on patients, but not really an example of what you were claiming. In the linked article, an infant required life-saving surgery which was not available at the hospital they were at, and getting to a hospital that could perform the surgery involved going through a Border Patrol checkpoint. This meant that in order to save the infant's life, the border patrol would have to allow the infant through the checkpoint, which could only happen by the hospital coordinating this transfer with Border Patrol.

And no, pt's are not asked about their immigration status; they are asked about insurance.

Hospitals collect the necessary information to get reimbursed for their services, this could be insurance information, Medicaid information, information needed to apply for Medicaid for the patient, private pay information, or immigration status which then dictates whether or not the patient gets reimbursed. Ideally hospitals would just treat everyone who needs treated, and then just tell a payer(s) what they owe them, but that's not how it works. Hospitals that care for a large population of undocumented patients are dependent on these reimbursements to simply exist. They could simply not ask, which would eventually result in there being no hospital for these patients to go to at all.

Specializes in ICU, LTACH, Internal Medicine.
The reimbursement that goes along with treating undocumented immigrants, and results in patients being asked about their immigration status, has been around for 13 years, and yet the ACLU hasn't been interested and I'm not sure why they would be.

Aside from HIPAA, which prohibits hospital staff from notifying any law enforcement agency that someone is a patient at your facility except in the case of an imminent threat to others, there is also the regulatory standards of physicians and nurses that prevents reporting patients to ICE. I can find no examples of nurses reporting patients to ICE, the only reported instance of a hospital reporting someone to ICE was when a hospital employee was using a fraudulent SS number.

I was asked this question in many forms (are you American; where are you from; are you a citizen; when are you going to come back; etc.) several times in ER. When I refused to answer, the explanation was either "we just need it for our stats but that's ok, iamjustdoingmyjob" or "I am just curious". In all cases, my insurance card was already on file, so it hardly might be due to concerns about my ability to pay.

Another time, my then "nurse" manager (I put "nurse" in commas because I do not think that she could be named like one) gave the patient, who was openly racist toward staff, my personal data and number to call so he could check my immigration status and make sure I did not take a job from any "real American nurse". I was already a citizen at that point, so nothing could happen, but the whole experience was beyond unpleasant. I have no doubts that many nurses in that unit would "report" an illegal immigrant if given a chance to do so - luckily, the place was absolutely paranoid about HIPAA as well.

Re. ACLU, it will take a whole lot of time, energy and political connections to get them involved, but it is definitely not impossible if one gets determined enough and has the right, well established connections among the right circles of people.

That's loosely related to your statement that nurse's are calling ICE on patients, but not really an example of what you were claiming. In the linked article, an infant required life-saving surgery which was not available at the hospital they were at, and getting to a hospital that could perform the surgery involved going through a Border Patrol checkpoint. This meant that in order to save the infant's life, the border patrol would have to allow the infant through the checkpoint, which could only happen by the hospital coordinating this transfer with Border Patrol.

Hospitals collect the necessary information to get reimbursed for their services, this could be insurance information, Medicaid information, information needed to apply for Medicaid for the patient, private pay information, or immigration status which then dictates whether or not the patient gets reimbursed. Ideally hospitals would just treat everyone who needs treated, and then just tell a payer(s) what they owe them, but that's not how it works. Hospitals that care for a large population of undocumented patients are dependent on these reimbursements to simply exist. They could simply not ask, which would eventually result in there being no hospital for these patients to go to at all.

No, not loosely related at all. A hospital staff member reported the parents to ICE. As for immigration status inquiries at hospitals, they shouldn't be asking. They ask about whether a pt. has insurance or does not have insurance. If not, they are referred to the business office to work out a payment plan. Immigration status does not come in to play.

I was asked this question in many forms (are you American; where are you from; are you a citizen; etc.) several times in ER. When I refused to answer, the explanation was either "we just need it for our stats but that's ok, iamjustdoingmyjob" or "I am just curious". In all cases, my insurance card was already on file, so it hardly might be because concerns about my ability to pay.

Another time, my then "nurse" manager (I put "nurse" in commas because I do not think that she could be named like that) gave the patient, who was openly racist, my personal data so he could check my immigration status and make sure I did not take a job from any "real American nurse". That ended badly for both of them.

Re. ACLU, it will take a whole lot of time and political connections to get them involved, but it is definitely not impossible if one gets determined enough and has the right connections among the right circles of people.

I've read where Amnesty International has been known to get involved as well.

Specializes in Critical Care.
No, not loosely related at all. A hospital staff member reported the parents to ICE. As for immigration status inquiries at hospitals, they shouldn't be asking. They ask about whether a pt. has insurance or does not have insurance. If not, they are referred to the business office to work out a payment plan. Immigration status does not come in to play.

You may want to re-read the article, it doesn't say that a hospital staff member called ICE because they found out a patient was undocumented, it says that a sick infant required a transfer to another hospital to get the treatment they needed, and to get there they would have to go through a border patrol checkpoint, which then required coordination with Border Patrol to get them through the checkpoint.

From your article:

"To make Isaac well, Oscar and Irma Sanchez would need to take their infant son to Driscoll Children's Hospital, in Corpus Christi, Texas. It was just a couple of hours up the highway, but for them it was a world away.

The Sanchezes, who are undocumented, would need to pass a Border Patrol checkpoint."

Hospitals do ask about insurance, but I think you might be missing why they ask, it's not random curiosity, it's because it's one of a few different ways that hospitals get reimbursed, which is also why hospitals often ask about immigration status. Again, a hospital that serves a large undocumented population would quickly go into the red without these reimbursements, which means eventually it would no longer exist. So really hospitals ask about immigration status so that they can continue to provide treatment to undocumented patients.

Another time, my then "nurse" manager (I put "nurse" in commas because I do not think that she could be named like one) gave the patient, who was openly racist toward staff, my personal data and number to call so he could check my immigration status and make sure I did not take a job from any "real American nurse".

Well, I do hope there were serious ramifications for that move. Beyond egregious. What miserable human beings, both of them.

The only thing I could think of was the fact the other countries provide insurance coverage for their citizens? But that still wouldn't be a triage question (by EMTALA). Interesting...following.

Specializes in ICU, LTACH, Internal Medicine.

If a Briton gets into US hospital, the national insuranse system of the GB won't pick up the tab. He would have to get special travel insurance before the trip - or pay out of pocket. Or just leave the country in time and let us pick up the slack. Same will happen with all other national insurances.

I am coming closer and closer to conclusion that they do it just because they can and because people sheepishly follow every stupid "requirement" they are asked for. When a beauty salon "requires" every client to provide a whole bunch of private info including email, two alternate phones and "emergency contact" and an application for hospital privileges for an NP requests name, SSN and contact info of the spouse of the applicant, I just do not buy any further explanations. That just makes no sense. Characteristically, I refused both and was told that it was ok, "we just want to know more about you". Huh?

You may want to re-read the article, it doesn't say that a hospital staff member called ICE because they found out a patient was undocumented, it says that a sick infant required a transfer to another hospital to get the treatment they needed, and to get there they would have to go through a border patrol checkpoint, which then required coordination with Border Patrol to get them through the checkpoint.

From your article:

"To make Isaac well, Oscar and Irma Sanchez would need to take their infant son to Driscoll Children's Hospital, in Corpus Christi, Texas. It was just a couple of hours up the highway, but for them it was a world away.

The Sanchezes, who are undocumented, would need to pass a Border Patrol checkpoint."

Hospitals do ask about insurance, but I think you might be missing why they ask, it's not random curiosity, it's because it's one of a few different ways that hospitals get reimbursed, which is also why hospitals often ask about immigration status. Again, a hospital that serves a large undocumented population would quickly go into the red without these reimbursements, which means eventually it would no longer exist. So really hospitals ask about immigration status so that they can continue to provide treatment to undocumented patients.

We'll agree to disagree. This is not the way it has worked at any institution I have worked in in my 25 year nursing career. The uninsured are referred to the business office or client affairs and payment plans are arranged. No immigration status involved.

If a Briton gets into US hospital, the national insuranse system of the GB won't pick up the tab. He would have to get special travel insurance before the trip - or pay out of pocket. Or just leave the country in time and let us pick up the slack. Same will happen with all other national insurances.

I am coming closer and closer to conclusion that they do it just because they can and because people sheepishly follow every stupid "requirement" they are asked for. When a beauty salon "requires" every client to provide a whole bunch of private info including email, two alternate phones and "emergency contact" and an application for hospital privileges for an NP requests name, SSN and contact info of the spouse of the applicant, I just do not buy any further explanations. That just makes no sense. Characteristically, I refused both and was told that it was ok, "we just want to know more about you". Huh?

Don't play their game. :)

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