Patients who use alias names - an ethical dilemma

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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/magazine/21FOB-ethicist-t.html?ref=magazine

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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.

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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.

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Specializes in O.R., ED, M/S.

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.

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Specializes in Cardiac Telemetry, ED.

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.

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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.

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Specializes in interested in NICU!!.

what is the right legal thing to do in circumstances like these?

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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.

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Specializes in IMCU.
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.

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Specializes in IMCU.
what is the right legal thing to do in circumstances like these?

yes please. does anyone know for sure?

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Specializes in IMCU.
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.

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Specializes in Vents, Telemetry, Home Care, Home infusion.

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

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