Patients who use alias names - an ethical dilemma

  1. A nurse presents this situation to an ethicist:

    I am a nurse-midwife. Some of my pregnant clients are illegal immigrants from Mexico who are treated under a federally financed migrant-workers' health-care program using their real names. They are sometimes employed under an alias. When they miss work for appointments or their deliveries, I'm asked to write excuses using those aliases. I would ordinarily write such an excuse, but must I refuse unless I can use a real name?
    http://www.nytimes.com/2009/06/21/ma...l?ref=magazine
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    About Anxious Patient

    Joined: Mar '07; Posts: 1,101; Likes: 1,979
    housewife and mother; from US

    12 Comments

  3. by   caliotter3
    I would refuse unless you are given a real name. Since you have no intent to otherwise use their name, they should have no qualms in giving it to you to get what they want. Otherwise, they can go without a note.
  4. by   caliotter3
    BTW I recently asked my doctor for a doctor's statement which they said they would give to me. When they turned around and didn't give me the statement, I made the decision to find another doctor. There was no deception involved. These people can not force someone to participate in their deception. They can take their business elsewhere.
  5. by   shodobe
    I would. You are compounding the illegal immigrant issue by decieving others. They only come here for the free medical they get and to get their child born here so they get to stay here and raise a citizen of the US! It is very hypocritical of us.
  6. by   Virgo_RN
    My obligation as a bedside RN is to provide the best nursing care I am able to all of the patients who are assigned to me, regardless of my feelings about illegal immigration. However, writing such a note as described would make me an accessory to fraud, so I would decline that request.
  7. by   caliotter3
    Quote from Virgo_RN
    My obligation as a bedside RN is to provide the best nursing care I am able to all of the patients who are assigned to me, regardless of my feelings about illegal immigration. However, writing such a note as described would make me an accessory to fraud, so I would decline that request.
    Aside from what, if any, my personal opinions of any of this are, I would refuse to be an accessory to fraud and that is the reason that I would decline.
  8. by   Chapis
    what is the right legal thing to do in circumstances like these?
  9. by   Batman24
    I wouldn't fill in any name. I would provide the care needed, give them the note to return to work so they don't lose their job, and I wouldn't have to commit fraud to do so. Leave the name completely out of the equation.

    "Pls excuse from work 3 days."

    "May return to work as of 6/22."

    It's generic but it would do the trick. If anyone disagrees they could then do it but I wouln't.
  10. by   DolceVita
    Quote from shodobe
    I would. You are compounding the illegal immigrant issue by decieving others. They only come here for the free medical they get and to get their child born here so they get to stay here and raise a citizen of the US! It is very hypocritical of us.
    Actually they cannot stay to raise their US citizen child. If they are caught they go into deportation proceedings. It is no longer permitted for judges to take into account the potential hardship of splitting up a family.


    Back to the topic...

    This make no sense to me. They are treated under a fed funded program for migrant workers but they are in fact undocumented aliens -- so they must be using an alias when they present themselves to the facility or they couldn't be treated as a migrant worker. But they work under yet another alias?

    How on earth does anyone know they are here illegally? Are these patients actually saying this to the nurse..."oh hey, by the way I am an illegal alien and this is not really my name"? Not so smart.

    If you are looking after someone officially was treated under that name, why wouldn't you provide a note under that name? If the name for the note was different from the name in the chart -- um no way.
  11. by   DolceVita
    Quote from chapis
    what is the right legal thing to do in circumstances like these?
    yes please. does anyone know for sure?
  12. by   DolceVita
    Quote from caliotter3
    Aside from what, if any, my personal opinions of any of this are, I would refuse to be an accessory to fraud and that is the reason that I would decline.
    With that stance then you wouldn't be able to treat them -- that certainly would accessory to fraud.
  13. by   NRSKarenRN
    As Central intake Manager for a homecare agency entering 24,000 patients and 6,000 doctors/year I run across this issue frequently.
    Patients will often use one name (when divorcing spouse, newly married/remarried, common law relationship, religious name) and yet have a different name under insurance provider.

    How our organization handles it is list name per insurance program paying for care. Other name is listed in parenthesis.

    Examples
    Referral comes in: Luke Skywalker. Insurance listed as Lucas Skywalker-Brown.
    Computer entry Last Name: Skywalker Brown (Skywalker) First Name: Lucas (Luke)

    Referral name: Smith, Lucy. Computer has existing patient with same DOB SS#, and insurance listed as Grushiem, Lucy. Check of insurance policy shows name is: Smith, Lucy
    Computer entry changed to Last Name: Smith (Grushiem); First Name: Lucy

    Doctor listed as Grace Ali MD. State Board of medicine website lists: Gracia Fernandez el Ali
    Compute entry: Last name: Fernandez el Ali (Ali), First Name: Gracia (Grace).

    When DOB is different between insurance payers: initially covered under Medical assistance or insurance with 11/04/1939 and later Medicare shows 11/05/1929 --date on birth/baptismal certificate we place notation in insurance section and change DOB listing to reflect info new payer has ---also inform patient in case honest mistake made in transcribing handwriting at insurance company.

    Other organizations choose to use AKA.

    We also fill out "Change of Information" form to document that we've changed name in system and accounts for difference in prior documents/billing, including insurance verification printout.

    This way covers all bases. We also fill out "Change of Information" form to document that we've changed name in system and accounts for difference in prior documents/billing, including insurance verification printout.

    This simple method could work for both situations.

    Leaving name off a form, is leaving practitioner open to being abused and photocopied for other users unless patient specific identifier like episode number included on form.

    Pactice name + providers listed
    Pracrice address = Phone#.

    Name: _________________________________ EP: 076245
    Address:________________________________

    The above named patient has been under my care. They may return to work /school effective abc date.

    Signed,
    Suzy Nurse CRNP
    Last edit by NRSKarenRN on Jun 21, '09
  14. by   caliotter3
    Quote from DolceVita
    With that stance then you wouldn't be able to treat them -- that certainly would accessory to fraud.
    But I doubt that they would have informed me that they were using an alias prior to the care being rendered.

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