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Physicians Rally the Vote for Patients in the Hospital on Election Day

Butcher, Lola

doi: 10.1097/01.EEM.0000697692.52883.ce
    voting, election, presidential election
    voting, election, presidential election:
    Kelly Wong, MD, talking with a patient about voting from his ED bed.

    An emergency medicine resident who helped patients vote from their hospital beds in 2018 has emerged as a leader in a nationwide movement to give patients access to the ballot box.

    Patient Voting, a nonpartisan organization founded by Kelly Wong, MD, now a fourth-year resident at Warren Alpert Medical School of Brown University, maintains a website that offers step-by-step guidance on patient-voting rules for every state. The organization also developed a network of medical students, residents, and other volunteers who are spearheading voter assistance efforts for patients in several states.

    Their work is part of a growing effort to increase voting among patients and their health care providers. Patient Voting joined Vot-ER, which facilitates voter registration in emergency departments, and other groups to participate in Civic Health Month, a collaboration that encourages health care organizations and providers to promote voter registration throughout August.

    The Emergency Medicine Residents' Association named Dr. Wong Resident of the Year in 2019 in recognition of the initiative. Three years earlier, she had become concerned about patient voting in the days just before the 2016 presidential election. “I was caught off guard when patients said, ‘Oh, I can't be admitted to the hospital—I know I'm sick, but I would rather go home and vote,’” she said. “That really touched me.”

    As the midterm elections approached in 2018, Dr. Wong researched Rhode Island election law to determine the multistep process that a hospitalized patient can use to request and submit a ballot on Election Day. She shared information with patients and also with her colleagues. “The internal medicine team focused on the patients they thought were going to be hospitalized on Election Day and made sure that they had the resources and, if they needed help delivering applications or ballots to the Board of Elections, they tried to figure out how to do that,” Dr. Wong said.

    Her hospital serves many patients who live in Massachusetts, so Dr. Wong researched that state's election law as well. She began to see that rules for emergency absentee ballots vary widely and are often difficult to understand.

    “I had like 20 tabs open, and I couldn't figure it out myself based on the state website because it was too confusing,” she said. That prompted the idea for the Patient Voting website, which aims to make it easy for patients, family members, and health care providers to learn the rules that apply to their state.

    Stemming Disenfranchisement

    That resource is needed, said James McKenzie, DO, currently a fellow of child and adolescent psychiatry at Ann and Robert H. Lurie Children's Hospital of Chicago. He helped start a similar patient voting effort when he was a resident at Cambridge Health Alliance in Massachusetts in 2016.

    Figure: has flyers, brochures, and stickers like the one above that physicians can share with patients at

    “In every state, there is some way for people to vote, so they are not disenfranchised by medical issues,” he said. “But nobody in the hospital was really aware of it and, when we called the local election commission, we found a lot of the people there didn't know the specific laws that apply to this population.”

    At least 38 states allow voters to use an emergency absentee ballot in the event of a medical emergency such as unforeseen illness, confinement to a medical facility, disabilities, or injury, according to the National Conference of State Legislatures.

    The process for casting such a ballot varies widely. In six states—Arizona, California, Georgia, Minnesota, Vermont, and West Virginia—election officials will deliver an absentee ballot to a voter confined because of a medical emergency. More commonly, ill or injured voters must find someone to do the legwork for them. Voters in Arkansas, Colorado, Connecticut, Florida, Illinois, Nebraska, Nevada, New Mexico, North Carolina, North Dakota, Ohio, Pennsylvania, South Carolina, South Dakota, Tennessee, and Utah who are hospitalized on Election Day may designate someone to request, deliver, and submit an absentee ballot to local election officials.

    At Cambridge Health Alliance, Dr. McKenzie and another resident working through the Social Justice Coalition distributed information about emergency absentee ballots to patients and encouraged them to enlist family members to help them vote.

    “We probably delivered about a dozen ballots ourselves for patients who didn't have anyone to serve as their proxy,” he said. “We had to go pick up the paper ballot, bring it to the voter, and then take it back” to the election board.

    Universally Appreciative

    Judd Flesch, MD, a pulmonary critical care physician at Penn Presbyterian Medical Center and the site director for its internal medicine residency program, helped a medical student start a patient-voting initiative at the hospital in 2016. Since then, voting assistance has been available to the hospital's inpatients for every local, state, and national election, and the Penn Votes program has expanded to include the Hospital of the University of Pennsylvania in Philadelphia.

    Medical students and other volunteers do most of the ballot pick-up and delivery, but when demand was heavier than expected in the 2018 mid-term election, Dr. Flesch jumped in to deliver ballots himself. “I have never seen patients be more universally appreciative of anything,” he said. “Voting is something that patients see as a core function of their humanity, and this is a way we can maintain that despite their being hospitalized.”

    He advises physicians who wish to start patient voting initiatives to work with their hospital's government affairs office. By doing so, Penn Votes' leaders have been invited to present their program to Philadelphia election officials and asked to give feedback about proposed voting changes.

    Dr. McKenzie's advice is to encourage hospital leadership to make patient voting assistance a standard practice. Resident-led initiatives are difficult to sustain when program champions finish their training.

    Dr. Wong, meanwhile, said she hopes that all physicians will consider how they can encourage patient voting. The Patient Voting website provides informational material that can be downloaded for distribution. “Involvement in patient voting can be just committing to talking to your patients so they know that this is their right even if they are in the hospital,” she said.

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    Ms. Butchercovers health care policy and business of health care issues, trends, and controversies for publications read by physicians, health system leaders, and the public. She is a member of the Association of Health Care Journalists. Follow her on Twitter@lolabutcher.

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