Immigration activists and several legal experts say a women's health clinic committed a breach of trust when it called the police after an undocumented patient presented false identification at a doctor's appointment earlier this month.
Blanca Borrego presented a fake Texas driver's license at Memorial Hermann's Northeast Women's Healthcare Clinic in Kingwood, Texas, when checking in for an appointment, the Los Angeles Times reported.
Borrego's daughter, one of two of her children who was with her at the time, says she was eventually taken to an exam room where sheriff's deputies arrested her, after they also found a fake Social Security card in her purse.
For about 18 months Borrego had been seeing Dr. David Bonilla at another office to treat a painful abdominal cyst, her daughter told the Times. A staff member at the Kingwood office had asked her to fill out new paperwork and provide identification and a card proving she was covered under her husband's employer-based insurance.
Alex Rodriguez Loessin, a Memorial Hermann spokeswoman said in a statement to Modern Healthcare Thursday evening that the health system considers this an opportunity to evaluate its processes. She said staff don't ask patients about their immigration or residency status, and that the situation in question was a "unique event" in the system's history that had "nothing to do with immigration or residency status."
When Borrego was unable to present another valid form of identification, staff at the clinic contacted the licensing bureau of the Texas Department of Public Safety (DPS) in hopes of verifying the license, Loessin said. Officials there told staff to contact local law enforcement to verify the driver's license, and the local sheriff's office ultimately decided to arrest her when the ID was determined to be false.
"We did not ask for this individual to be arrested," Loessin said. "This is a decision that was made by law enforcement, including the District Attorney's office. We did not press charges. We simply called DPS to question a potentially false identification."
“In this case, law enforcement was called because of a potentially false identification presented at the clinic. Memorial Hermann was never aware of the patient's resident status, and first heard of her resident status when it was reported by media,” Loessin said. “Memorial Hermann does not exclude, deny benefits to, or otherwise discriminate against any person who presents at any of our facilities."
When asked whether Memorial Hermann has a policy in place that prompts staff to verify patients' identification with law enforcement, Loessin reiterated that it was "truly a unique event and the decision to call DPS was a staff decision."
Borrego's attorney, Clarissa Guajardo, did not respond to a request for comment, but told the LA Times that she was awaiting her client's release late Tuesday after bond was posted. Immigration officials had not placed a hold on her, nor had they contacted her family or her attorney, the Times reported.
Although many experts say that the situation endangers the confidentiality of the doctor-patient relationship, it's not necessarily against the law.
Laura Palmer, a senior fellow at the Englewood, Colo.-based Medical Group Management Association, said it's standard procedure for most physician offices to ask for ID to guard against medical identity theft, and it's often advised by provider manuals created by payers.
Palmer, who worked as a practice administrator for 20 years, said her staff wasn't instructed to call the police if they thought an ID was fake, but they would ask for a second form of identification.
The privacy rule of the Healthcare Insurance Portability and Accountability Act allows covered entities to report protected health information—which would include information on one's driver's license—if it is believed to be evidence of a crime that occurred on the entity's premises.
Clinton Mikel, a partner at Southfield, Mich.-based Health Law Partners, argued that it's likely the mere possession of a fake ID was a crime that occurred on the offices' premises, and therefore the law permits them to share the information, even if the crime doesn't directly affect the healthcare provider.
Mikel also pointed out that there could be insurance fraud issues if she or her husband lied to their insurer about their legal status or used false documents to obtain coverage.
But Erin Fuse Brown, an assistant law professor at Georgia State University and an expert in healthcare law, questioned whether the doctor's staff could release Borrego's name and other protected health information to the police simply because they believed that she was presenting false identification.
“It goes against the whole doctor-patient relationship, a relationship that is cloaked in trust and confidentiality and loyalty,” Brown said. “And if you put this sort of requirement on healthcare providers to take care of their patients and students, then that would destroy the trust that is inherent in the relationship.”
Unless Borrego was trying to defraud the office by giving a false name in an attempt to obtain healthcare she's not entitled to, it seems unusual that the physician would feel compelled to report her, Brown said. Physicians are allowed by HIPAA, and in some instances compelled by law, to report instances of child abuse, violent crime or other imminent dangerous behavior, but those exceptions don't seem to apply here, Brown said.
Concerns about being turned over to immigration authorities is a recognized barrier for immigrants to access healthcare, said Nancy Berlinger, co-director of the Undocumented Patients project at the Hastings Center, an independent research institute focused on ethics and health policy.
“It is an undocumented immigrant's worse nightmare,” Berlinger said. “This is a person who went for routine healthcare. She had a reason to go, and she was arrested and separated from her children.”
Texas is considering allowing undocumented immigrants to obtain a driver's license, a move that 12 states and the nation's capital have taken, Berlinger said.
Providers have often pushed back when lawmakers have asked them to collect data on undocumented individuals, arguing that it's not within their purview.
“Doctors say these are usually un-insurance problems and not undocumented” problems, Berlinger said. “Being undocumented itself is not a healthcare problem. The problem is that they don't have an ability to pay for healthcare.”
According to the Healthy Americas Institute at the University of Southern California's Keck School of Medicine, a research center focused on improving health in Hispanic communities, 35% of undocumented immigrants have insurance. Advocates worry that episodes like the one in Texas could prevent even insured undocumented individuals from accessing care before it threatens their life. That could put a heavier load on the country's emergency rooms.
“Unfortunately, I'm sure we can expect to see undocumented residents who have health insurance not use it and delay care, and may very well be putting their health at risk because of this fear,” said Adolph Falcon, senior vice president of the Washington-based National Alliance for Hispanic Health.
Clarification, September 28,2015:
Memorial Hermann did not call police to report that Borrego was an undocumented immigrant, but rather called state and local authorities to verify her ID because they believed it was fake. As stated in the story, the health system's staff were unaware of her residency status.