For four months, a woman known only as Jane Doe lay in a bed in a Philadelphia hospital, alive but unable to do anything other than involuntary actions.
Staff at the Hospital of the University of Pennsylvania didn't know her name or how old she was, although they estimated she was in her 40s. They also didn't know exactly how she came to be in what her doctor says is a persistent vegetative state.
According to The Philadelphia Inquirer, she was transferred to Penn from another Philadelphia hospital, where paramedics rushed her after finding her in cardiac arrest in a park. It took doctors 45 minutes to get her heart beating again.
Dr. Charles Baillie, an attending physician at Penn who's been treating the woman for about two weeks, said she did not get enough oxygen to her brain during the time it took to resuscitate her.
"She can still do spontaneous things, like open her eyes, but she has no higher-level functioning and can't do anything purposefully," said Baillie. The condition, he said, is permanent.
Months after hospital staff started the search for the woman's identity and loved ones, Baillie said Bateman had no identification with her when she was transferred from the other hospital, Aria Health's Frankford Campus. Because of her condition, hospital staff knew they had to identify their Jane Doe and find her family so they could determine how aggressively to treat her.
"The main concern was always that if something did happen, like a cardiac event, how aggressive would she have wanted to be and were we acting in a way she would have wanted," said Baillie. "The default action is that we act as if somebody would want us to be aggressive. It's always difficult to treat somebody if we have nobody to talk to about treatment."
With cases like this Jane Doe's, experts say it's vital to locate loved ones to make treatment decisions in the unidentified person's best interests. They also say there are many challenges when it comes to identifying and treating Jane or John Does because of regulations surrounding privacy and hospital responsibility.
Wide-Reaching Effort to Identify Jane Doe
Patricia Meehan, the hospital's associate director of clinical resource management and social work, spearheaded the effort to find the then-unidentified Bateman's relatives.
But before proceeding, the hospital was required to appoint a guardian who could make decisions on Bateman's behalf.
"We had a guardian put in place so we could continue to work on her behalf to try and find somebody," said Meehan. "From that point on, we worked with the guardian and asked if we could go to the media."
They first went to the media in September, but no one came forward. After that, Meehan said she and other social workers contacted numerous community organizations and mental health agencies. They also worked with the police department to get her photos circulated nationally.
At the same time, Bateman's relatives told the newspaper they were searching for her as well. They said they filed a missing persons report, but the Philadelphia Police Department claims to have no record of it. Relatives also say Bateman has a criminal record, including arrests for prostitution and drug possession, so her fingerprints were in the system.
Police, however, were unable to match them to the then-unidentified Bateman when requested by the hospital. The department told the paper it is trying to determine what happened to the missing persons report, and doesn't know why her fingerprints couldn't be matched.
After the hospital did a lot more database searching and called other agencies, Meehan said they decided to appeal to the media again. That's when they started getting calls about her.
"Eventually, we heard from extended family members who then went to her immediate family members' homes and let them know she was here," said Meehan.
Meehan said there have been a few other cases of unidentified patients, but none of these mysteries has ever taken as long to solve as Bateman's.
"It's usually taken just a few days to find people," she said.
Other medical centers, on the rare occasions they say they encounter unidentified patients, take measures similar to the ones the Hospital of the University of Pennsylvania took.
"We have these from time to time at Beth Israel Deaconess Medical Center, and mobilize social work and other staff, sometimes involving the police as U Penn here did, to track down every possible lead we can find that will help us make the best patient-centered decisions possible," said Dr. Lachlan Forrow, director of the ethics support service at Beth Israel Deaconess Medical Center in Boston. "I cannot remember a case where [it's taken as long as at Penn], and deeply admire their persistence."
Forrow said it's vital to track down family in order to help make difficult decisions about prolonging life. Otherwise, a court-appointed guardian may be the hospital's only option.
"We would still virtually always seek court-appointed guardianship to ensure that the patient has someone with the clearest possible society-sanctioned authority to sign off on any care plan," he said.
Privacy Issues Also a Challenge
Meehan said one of the organizations she sought out was The Doe Network, an entirely voluntary, web-based center that helps law enforcement identify both the living and the dead. The Doe Network said it received an inquiry on Bateman, but didn't get the information they needed to include her in the organization's international database. By that time, she had already been identified.
Todd Matthews, The Doe Network's media director, said while there's no expectation of privacy with dead bodies, that's not true for unidentified people who are still alive.
"There's a level of privacy that's expected," said Matthews. "For example, a living person's dental records should never be available on a public database. If this person regains consciousness, people may find out she has a serious medical condition or something else that's very private."
Matthews also said there's no set of protocols for dealing with living Jane Does, in part because they're so rare.
"Right now, we work on a case-by-case basis, and it's based on local law enforcement's procedures."
Meehan, the social worker at the Hospital of the University of Pennsylvania, said Bateman's family is trying to adjust to news of her condition. The hospital also said lawyers are now working on transferring guardianship to Bateman's family.
While saddened by the news about Bateman's condition, Meehan said she is very glad her family is with her.
"We are relieved, and appreciate the family will now be a part of her care."