Hospital takes on big operation: finding a patient’s lost identity

Nurse Maciel Ponce knew her patient in Room 326 enjoyed watching telenovelas. That he smiled when she sang to him in Spanish. That he got embarrassed when she called him handsome.

But there was so much she didn’t know.

It was early October when paramedics found him lying in an alley and took him to Lakewood Regional Medical Center. When he arrived, he couldn’t say his name clearly or remember anything about himself.

He carried no identification.

The hospital enlisted the help of the L.A. County Sheriff’s Department, which took his fingerprints and determined his identity from a misdemeanor record for public intoxication: Guillermo Munoz, born Feb. 10, 1956.

Officials would not disclose Munoz’s diagnosis but said he suffered from loss of memory and speech and the ability to stand or walk. The symptoms are consistent with those of a stroke.

After about eight weeks, doctors had done everything they medically could for Munoz. But he still couldn’t take care of himself. He needed help brushing his teeth, changing clothes, even going to the bathroom.

Without somewhere to send him, hospital officials said, they couldn’t release Munoz. Releasing patients who are homeless or without family can be especially difficult, raising legal and ethical questions.

Some Los Angeles hospitals are under investigation for allegedly dumping patients on skid row. And state and local politicians are considering laws that would make it a crime for hospitals to release patients on the street.

But Lakewood Regional officials said their first concern was for Munoz’s care.

“This is a universal problem,” said David Langness, a spokesman for Tenet Healthcare Corp., which owns the Lakewood hospital. “We made every effort that we could to make sure Mr. Munoz was taken care of properly, that he wasn’t abandoned.”

At the same time, Langness said, the hospital knew it couldn’t keep him indefinitely. As officials searched for his family, they also began looking for a skilled nursing facility to place him.

“We are supposed to treat, stabilize and release patients,” Langness said. “Often, hospitals just can’t find a place that will take these patients.”

Unfortunately, patients like Munoz are not that rare and are difficult to deal with on many levels, said Jan Emerson, spokeswoman for the California Hospital Assn.

Doctors have no way of figuring out the patients’ medical histories, so they often end up treating the symptoms rather than any underlying medical problems. Also, finding patients’ family members can be labor intensive as social workers turn to police, media and community groups for help. And then there is the practical problem of reimbursement, Emerson said.

“First and foremost, the hospital is going to care for that patient,” Emerson said. “We have a legal obligation to provide care to them until they no longer need care....But we are providing the care, and we are not getting paid for it.”

If a hospital can determine a patient’s identity, it might be able to find insurance coverage. And occasionally the patient can qualify for emergency Medi-Cal. But often, Emerson said, “you chalk that up to unreimbursed care.”

Dr. Tom Rosenthal, chief medical officer for UCLA Medical Center, said social workers usually follow a procedure to determine the identity of unknown patients and are successful in most cases. But that doesn’t always make placement easier. Sometimes, the hospital ends up keeping patients longer than medically necessary, in beds that other prospective patients are waiting for, as officials search for places to transfer them.

“These are very challenging cases,” Rosenthal said. “Because they have no insurance, no home and no one to care for them, their placement is really quite a challenge.... If you have a sense of morality, you don’t just toss somebody out on the streets.”

In their quest to find the unknown patient’s family, Lakewood hospital officials checked with the Mexican Consulate to see whether it had records of him. They checked with the Los Angeles County public guardian’s office to see whether he had a conservatorship. They called the California Department of Social Services to ask whether he was receiving public benefits. They didn’t know whether he was a citizen, a green-card holder or an illegal immigrant.

They created English- and Spanish-language fliers for the media. It included a photograph of Munoz, a thin man, about 5 feet 4, with well-worn skin, crooked teeth and a scar on his nose. The caption reads: “Do you know this man? Hospital seeks family or friends of patient who is unable to speak.”

As officials searched for his family, they also looked for a way to pay Munoz’s mounting bills. His care was costing the hospital $2,000 to $2,500 a day. He didn’t have insurance coverage. And he didn’t qualify for Medi-Cal.

In the end, the hospital decided to write the bill off as “charity care,” Langness said.

Ponce, the nurse, said it was frustrating not being able to find Munoz’s family. “Someone out there is worried about him,” she said.

Not wanting him to be lonely, Ponce often spent her breaks with Munoz, showing him magazines or turning on Spanish-language television stations. She brought him Mexican candy and barbecue dinners from a nearby restaurant. She took him on walks in his wheelchair and cut his hair regularly.

Hospital staff even threw him a birthday party, complete with balloons.

“He became part of our Three West family,” Ponce said, referring to his room’s third-floor location. “Some days he had good days; some days they weren’t so good.... It went day by day.”

When he seemed sad, Ponce and another nurse tried to cheer him up by singing Cielito Lindo, a folk song that to Ponce seemed particularly fitting. “Ay, ay, ay, ay. Canta y no llores.” Sing and don’t cry.

“I don’t think our singing was the best, but he didn’t care,” she said.

Munoz tried to speak, even though he couldn’t make himself understood. “It wouldn’t make any sense, what he was saying, but he would ramble on,” Ponce said. “He was constantly trying to talk. Sometimes we couldn’t get in our two cents.”

He even learned to say a few words in English: One day after Ponce fed him a meal, Munoz responded, “Thank you.”

Ponce and the other nurses asked him questions: Where are you from? Do you have children? Where do you live?

Munoz spoke of Maria, but he couldn’t remember whether she was his wife. He mentioned Guadalajara, Mexico, but didn’t know whether that was his home.

Last month, hospital officials found a nursing home in Lynwood for Munoz. He qualified for Medi-Cal coverage for care at the home, Langness said. Nevertheless, they are still searching for his family.

“We feel a responsibility to him,” Langness said. “We’ve developed a relationship with him. We want to try to see that his family, who must love him, finds him.”

Ponce said she planned to visit him at his new home.

“Maybe he will be happy if he sees a face he recognizes.”

anna.gorman@latimes.com