How to handle patients who don't have identification

Key Points

Is it legal and/or ethical to refuse to see a patient who has no identification? The answer hinges upon whether a physician-patient relationship has been formed.

In most jurisdictions, this relationship requires more than merely allowing a prospective patient to make an appointment. There usually needs to be some face-to-face contact with the physician and some action taken toward examination and/or treatment (or an agreement to take such action).

Keep in mind, though, that in some instances, this could occur on the telephone, as well as in person-if a history is taken, recommendations are made, and/or a statement by the physician assures the patient that he or she will be seen in the office.

You can refuse to see a patient for any reason, or for no reason at all, up until that time.

It is understandable that most offices require some form of identification from a new patient, if only to prevent insurance fraud. The type of ID is up to the individual physician/practice (with a possible exception that will be discussed shortly), so you can choose to limit it to a driver's license, some other form of government-issued identification (e.g., a passport), or something else.

There is a notable exception of growing importance in some areas of the country.

With new emphasis being placed on the problem of undocumented aliens during this decade, an increasing number of jurisdictions are requiring businesses to check IDs before hiring new employees, and this may be extended to providing identification before being treated by a physician as well.

While this isn't the case in most areas-and probably would not prevent treatment in emergencies-it is an emerging issue that needs to be kept in mind.

If you practice in a state that shares a border with Mexico, it might be wise to check to see if any new regulations have been promulgated there.

Legal issues aside, is it ethical to refuse to treat a patient because of a lack of appropriate identification? Ethical questions and their answers vary with jurisdiction, circumstance, and time.

My opinion is that where there is no emergency, and any suspicion at all that there is any issue of false identification, there is no ethical problem involved with a refusal to treat. Many physicians, for example, refuse to see patients who exhibit drug-seeking behavior.

On the other hand, suppose you were approached by an elderly patient whose mobility was limited (and who thus could not seek out a physician at a greater distance than your office) and who did not possess what your practice would consider appropriate identification.

Since this type of patient might be faced with a chronic illness that requires ongoing monitoring and control, without which their lives could be endangered, the ethical action would be to give the patient the benefit of the doubt and treat him or her.

The author is an internist and a health law attorney in Philadelphia. He can be reached at eshore@KaneShore.com. Malpractice Consult deals with questions on common professional liability issues. Unfortunately, we cannot offer specific legal advice. If you have a general question or a topic you'd like to see covered here, please send it to memalp@advanstar.com
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