How to deal with “unknown patients” in an emergency
You know that moment someone collapses in front of you. You rush them to the nearest emergency unit. You don’t know the person and there is no identification on them, translating to them being an unknown patient. The hospital paperwork gets tricky. And the questions come: who pays for care?
An unknown patient, unconscious or unidentified, or even unable to pay—could be anyone any day and anywhere, but it has emerged that there is no policy specifically how they should be handled when brought in for treatment.
Doctors have sworn an oath to provide care, but the presence of an unknown patient, crash victim, gunshot victim, trauma victim leaves the doctors in a medicolegal tangle. Health workers in the private sector, even the good Samaritan who finds an unconscious person on the street wants none of it.
Especially when the police gets involved. The police say a first responder has to report to the nearest station, and then the police will visit to get a history and investigate. After all, it could be a crime to cover up.
“I can assault someone, make an attempt to kill someone and then rush them to hospital,” says CSP Adegbite Titus, speaking for the FCT police commissioner Bala Ciroma at the 2019 Physicians’ Week which centred on the “Unknown Patient”.
Determining the relationship between the unknown patient and the responder, the cause of injury, the intent, the identity, tracing the contacts is a lot of work and takes a lot of time.
“That’s why it seems as if the police is not your friend when you try to help an innocent person,” says Titus. Even doctors complain of police harassment over unknown patients, especially gunshot victims.
There is no national database where the police can verify anyone is who they say they are, so they have to investigate.
“Someone who appears to be a good Samaritan could be the criminal behind it,” Titus insists.
Unknown patients are brought into hospital unconscious from trauma or accident, medical conditions as heart diseases or any other condition that impairs a patient’s ability to identify themselves.
Beyond the medicolegal front is finance. “The fear in private hospitals is who to pay,” says Dr Philips Ekpe, chairman of the Nigerian Medical Association in the FCT.
The National Health Act provides for emergency care covered by the Basic Health Care Provision Fund, “but the disbursement process is largely ambiguous.”
“It is sad to note that the Federal Ministry of Health is yet to put a template in place for judicious use,” he told a press briefing at the start of the 2019 Physicians Week in Abuja.
NMA said it was perplexed the federal health ministry is “concentrating on purchasing ambulances rather than rolling out mechanisms to address critical aspects of emergency care services.”
“How are you going to disburse for emergencies? What are the criteria, who is supposed to pay? They have not formed template and that makes it ambiguous,” said Ekpe.
“After treating an accident patient, how do you access the bill? these are nebulous and ambiguous. We need clarity of procedure on what to do.”
As yet, there is no clear line of paying for emergency care for treating gunshot victims, even though they are provided for in the Fund.
NMA said the government “has not deemed it pertinent to accord the desired attention and value to this category of patients, the unknown patients.”
In addition to gunshot victims, people involved in road crashes account for a large number of unknown patients.
“There is a lack of commitment to the implementation of the National Health Act, which reasonably provides for the care of patients in emergencies including those with identity challenge,” said Ekpe.
He explained to Daily Trust Saturday: “If a doctor is aware that when a patient is treated, he will be paid and not held liable, they will go all out and treat Nigerian patients.
“These are the components of universal health coverage where every Nigerian will be entitled to health, whether it is somebody without a home.
“Even if you are under the bridge and found unconscious, the police, Road Safety or any other Good Samaritan can take you to the nearest hospital, and the hospital will not say ‘no, we are not going to treat you because we don’t know your name, you cannot pay.’ No. That is the basic thing every Nigerian should have.”
The way doctors see it, unknown patients don’t have any means. “The patient cannot afford it, is not even conscious to talk to you. How we take care of them is what we are going to use to check if we are attaining universal health coverage.”