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View Full Version : coma patients with no relatives - how do caseworkers/social workers find info?



rowriter
08-13-2005, 12:58 AM
Hi there,

I'd be much appreciative if someone could enlighten me on this subject.

Say you have a person who gets in a car wreck and goes into a coma, and there are no relatives or friends to be found at first...I'm under the impression from my internet research that they become a "ward of the state" or the caseworker/social worker takes temporary custody to make decisions in that person's best interest until they can find someone...is this correct?

I'm also curious about how the social worker goes about finding relatives and friends of the person in the coma. Are there specific things they do first, and then resort to other methods, or is it just whatever they can find in whatever fashion they go about it? And if there is only a non-relative, do they try to get that person to become a guardian while the person is still in a coma? Does the social worker have the ability to search court documents such as marriage/birth certificates?

Thanks for any help on what I know are a lot of questions. Also if you have a site or a book to recommend, I'd love to hear about it. I'll admit I'm a little nervous to call our local hospital to ask someone-I'm scared they won't have the time or patience to answer my questions.

Rowriter

PattiTheWicked
08-13-2005, 04:24 AM
In Ohio, what they do is appoint someone as a guardian ad litem to make medical decisions for the individual. Recently, in a horrifyingly sad case, an infant boy was in a vegetative state due to shaken baby sydrome. Because the parents and grandparents were all suspects and witnesses in a criminal investigation, the child was turned over to state custody. Once the child was in the custody of the state, a judge appointed an attorney to be the kiddo's guardian ad litem, and granted the guardian medical power of attorney. Her job was to make decisions that represented the best interests of the little boy in question.

Later, the grandmother was cleared of any involvement and custody reverted to her, as did the right to make medical decisions on little Aidan's behalf.

Don't know if that helps any, but depending on the state you're writing about, you might Google the state name along with "guardian ad litem" to see what's up.

rowriter
08-13-2005, 04:31 AM
Thanks for the reply, PattiTheWicked!

It definitely helps to have a few more key words for the internet research, and interesting that they appointed a lawyer (I have only read about the hospital's caseworkers being guardians so far).

What a sad case...I hope Aidan can pull through it. :(

I'm researching for Colorado so I will see what I can find.

Thanks again!

PattiTheWicked
08-13-2005, 04:38 AM
It definitely helps to have a few more key words for the internet research, and interesting that they appointed a lawyer (I have only read about the hospital's caseworkers being guardians so far).

In Ohio, as far as I can tell, it's almost always attorneys. This is partly because sometimes an injunction has to be filed to keep the child on or take them off life support, and an attorney has to follow the letter of the law and be unbiased.


What a sad case...I hope Aidan can pull through it. :(


He won't, but at least he's with a grandmother who loves him and will care for him as long as she can.

WVWriterGirl
08-13-2005, 04:51 AM
I worked as a legal secretary in North Carolina years ago, and we had a case that, while the child was not ill or injured, was abandoned. It's similar, but not. In that case, the attorney I worked for was assigned to be guardian ad litem for the child in the absence of the parents. Luckily, the father was located (who was out of the picture from the start - he was the non-custodial parent), found to be competent, and custody reverted to him.

I think, as Patti states, the Guardian ad Litem is nearly always an attorney, although in North Carolina, I think it depended on what decisions needed to be made for the incapacitated/incompetent individual. Since your question is medical, it would probably be an attorney. I've seen, in cases of financial collection, the Guardian ad Litem duties be shared by an attorney and a bank executive.

WVWG

rowriter
08-13-2005, 07:29 AM
WVWG,

Thanks for the info, this is really interesting. If you don't mind me asking, do you remember who it was that found the child's father?

If the individual in a coma is an adult with semi-good insurance, I wonder if the insurance company has their own attorney as well?


PattiTheWicked,

Do you mean file an injunction with the state? like a Medicaid/Medicare?


I'm beginning to realize I need a law book, not a medical book.

WVWriterGirl
08-13-2005, 08:03 AM
Rowriter -

As it just so happens, I've also worked in the health insurance industry. Yes, they have their own attorneys and physicians on staff, and sometimes both collaborate to find the most cost efficient (read: not necessarily best) solutions for healthcare. I worked for a major third party administrator for four years, and I've never seen a case like this. I would imagine, had something like this happened, the claims examiner (me) would not have been privvy to the intricacies of the case; however, if in your scenario, they don't know the patient's name, how would they submit claims, records, preauthorizations, and appeals to their insurance carrier?

As far as finding the child's father, if I'm not mistaken, it was the attorney (my boss). He was quite pro-active and worked the case because the child was in jepoardy for a time (the mother abandoned the child at a truck stop, and we had so long before he became a permanent ward of the state - something the atty didn't want to happen). It took us a couple of weeks and several phone calls all across the country, but we found the dad.

If you have any other questions, feel free to ask away. I'll answer as best my experience allows!

WVWG

PS - in another thread in this section, I give out the web address www.allexperts.com (http://www.allexperts.com) - you might find someone there who works as either an attorney or healthcare worker who can answer your question, maybe even in the applicable state.

PattiTheWicked
08-13-2005, 05:12 PM
PattiTheWicked,

Do you mean file an injunction with the state? like a Medicaid/Medicare?


I was actually referring to injunctions that are sometimes filed in life-support cases. Sometimes a hospital -- or doctors -- will conclude that there is no benefit to the patient to remain on life support, and will basically say, "Hey, folks, we really need to just pull the plug." A guardian ad litem might, in this case, file for an injunction, which is a court order telling the hospital "No, you can't do that yet."

Or of course there was the Terry Schiavo case, in which her husband had to get a court order saying he COULD terminate life support measures.

rowriter
08-13-2005, 10:16 PM
I was actually referring to injunctions that are sometimes filed in life-support cases. Sometimes a hospital -- or doctors -- will conclude that there is no benefit to the patient to remain on life support, and will basically say, "Hey, folks, we really need to just pull the plug." A guardian ad litem might, in this case, file for an injunction, which is a court order telling the hospital "No, you can't do that yet."

Or of course there was the Terry Schiavo case, in which her husband had to get a court order saying he COULD terminate life support measures.

Ah, okay I understand that better now. Thanks for the clarification!

rowriter
08-13-2005, 10:32 PM
Rowriter - As it just so happens, I've also worked in the health insurance industry.<snip> .. I would imagine, had something like this happened, the claims examiner (me) would not have been privvy to the intricacies of the case; however, if in your scenario, they don't know the patient's name, how would they submit claims, records, preauthorizations, and appeals to their insurance carrier?
<snip>
If you have any other questions, feel free to ask away. I'll answer as best my experience allows!

WVWG

PS - in another thread in this section, I give out the web address www.allexperts.com (http://www.allexperts.com/) - you might find someone there who works as either an attorney or healthcare worker who can answer your question, maybe even in the applicable state.

Wow, thanks for all the help! I will check out that link, too. I'm sure I will have more questions, but we're going out of town today so I'll have to think on them.

Here is my basic scenario: a guy gets in a car wreck and goes into a coma (not a vegetative state, at least at some point in my scenario he will come out of it a couple/few months later-which I've read is rare but, I've read about cases like that too) - he does have ID and insurance card, so they know who he is, but they aren't able to find any relatives or even friends for several months. I don't know how plausible this is, but in my mind the guy is a real loner and is also arrogant enough to think nothing like this would ever happen and he'd never need anybody's help...therefore he doesn't keep contacts with anyone, not even a phone number for his parents (I was toying with the idea that they are dead already and he has no siblings).

Ok here's a question: how long does it take to make someone a guardian ad litem? Does it happen fairly quickly?

WVWriterGirl
08-14-2005, 03:24 AM
I can't really recall how long it takes, but I'm guessing its a couple of weeks, just based on the speed of the legal system. You have to get a court date, all interested parties must show (if not, there's a continuance), the judge hears the evidence/information, and if it's a complicated case, he may take time to form his opinion. Now, if it's a fairly large county/municipality (these are usually handled by county judges or magistrates) it'll be a dedicated judge for family or civil causes. If it is a rural setting, it's the same magistrate or judge (or two or three) for both civil and criminal matters, which could stretch things even further, timeline-wise. All parties involved (which would be, in the case of an indigent [which is what your guy is] the attorney, the judge, a representative of the hospital, and a state representative, like a social worker) must agree to the appointment of the guardian ad litem, and then all information regarding the patient would be transferred to the possesion of the attorney, if all parties agree. The attorney will then be called upon by both the hospital and the case worker when decisions regarding healthcare arise.

As far as the insurance company, well, unless there's some sort of experimental treatment necessary on the patient, they wouldn't be involved. Generally, experimental tx is not covered by insurance plans, and if the physician is dead-set to do the tx, a pre-authorization would be required, in which case the insurance company would be contacted and become involved.

Now, another question for you - if he has his wallet and insurance card, the name of his employer would be on the insurance card - they have to be. It wouldn't be a stretch for the hospital personnel to use that information to contact his employer and get a contact for his next of kin, which is required when you are hired in most places. Isn't that gonna pose a problem for your storyline? I know that not everyone is a health insurance claims examiner, but its one of those tricky things you've got to think about.

WVWG

rowriter
08-15-2005, 06:54 AM
Now, another question for you - if he has his wallet and insurance card, the name of his employer would be on the insurance card - they have to be. It wouldn't be a stretch for the hospital personnel to use that information to contact his employer and get a contact for his next of kin, which is required when you are hired in most places. Isn't that gonna pose a problem for your storyline? I know that not everyone is a health insurance claims examiner, but its one of those tricky things you've got to think about.

WVWG

Thanks, all this info really helps!

I was kind of imagining that the place where this dude works isn't a place that always follows the letter, and he just never filled out his "emergency contact" list (Or I would need to work out that he was hired 'as a favor' or something and never needed to go through the paperwork (now i'm trying to remember if any tax documents ask for relative info...I don't really want him getting paid under the table, makes it too complicated) . I was also playing with having the company he works for not get back to the hospital for several weeks even if they do have contact info...but I can see how that might pose a problem because that doesn't seem like the sort of thing that would slip through the cracks...

It really helps to know about all the different parties that are involved, (now I know there probably needs to be a lawyer in the picture) so far I had only thought of the social worker (whom I have employed by the hospital, so this may be a problem too...I have her working in a little office on the hospital grounds in a fairly large hospital in a large city, and actually have her working at several hospitals--I had imagined she was working for the state but that the hospitals provided her with a tiny space); I pictured the social worker being the one who has the contacts with insurance co. and who's trying to find relatives/friends.

Thanks again for all the info, I mucho appreciate it! :)

WVWriterGirl
08-15-2005, 09:27 PM
One way you could get around this is to have him have a private health insurance policy. They don't (as far as I know, I've never held one - you would have to find a private health insurance expert) require next of kin. It seems to me like they wouldn't - I mean, State Farm doesn't ask for your next of kin when you get a car insurance policy, do they? That's a form of private insurance. It may be feasable, and something you could look into.

Also, if you decide to go for a group insurance policy (as in, a work insurance situation), the employer is not obliged to give up that information; you could just make the employer really obstinate about following the letter of the law, as next of kin is considered "private and confidential" and is only to be used by the employer if an accident occurs while on the job.

WVWG

rowriter
08-17-2005, 01:40 AM
One way you could get around this is to have him have a private health insurance policy. They don't (as far as I know, I've never held one - you would have to find a private health insurance expert) require next of kin. It seems to me like they wouldn't - I mean, State Farm doesn't ask for your next of kin when you get a car insurance policy, do they? That's a form of private insurance. It may be feasable, and something you could look into.

Also, if you decide to go for a group insurance policy (as in, a work insurance situation), the employer is not obliged to give up that information; you could just make the employer really obstinate about following the letter of the law, as next of kin is considered "private and confidential" and is only to be used by the employer if an accident occurs while on the job.

WVWG

Thanks again for the ideas! I need to think further on how I will deal with this issue but this thread has really helped. I really appreciate you taking time out to answer my questions! :Hug2:

WVWriterGirl
08-17-2005, 08:20 AM
Not a problem. I thought maybe my little bit of legal experience might help someone out sometime along the way, but never in a million years did I think the health insurance junk would be any help. Glad I could help you!

WVWG