Batman’s Medical Records

Russel Saunders over at The League of Ordinary Gentlemen has mocked up a hospital record for Bruce Wayne. It reads remarkably like an actual medical history, which shouldn’t be surprising given that Saunders is a physician. But it winds up getting at a few legal issues about which some comment is merited.

First of all, reading this document should demonstrate, in part, just how hard it would be for a superhero or supervillain to maintain a secret identity. We talked about the difficulties inherent in alter egos about a year ago, but actually looking at what a medical record for a superhero might actually look like just drives the point home. If you go to the hospital, people do ask questions, and health care professionals are trained to ask uncomfortable questions about unexplained injuries. This is partly for the safety of the patient, as a lot of domestic abuse goes unreported until someone shows up at the hospital, and even then it can take some real prodding before the truth comes out. But it’s also partly for public safety reasons, as many people who wind up with unexplained injuries, especially things like gunshots or knife wounds, are involved in something slightly less than legal a lot of the time. While the doctors and nurses who actually provide medical care don’t usually care about whether someone was injured while breaking the law, police departments routinely call emergency departments and hospitals to see if suspects likely to have been injured have turned up.

Second, even though medical records are protected by privacy laws like HIPAA, once this information is out there it doesn’t just go away. If an enterprising Gotham City DA ever suspects that Wayne is up to something untoward, he can get a warrant for Wayne’s health records. All of this information—including the little speculative note at the end of the record—will come out, all of which will put a DA that much closer to putting the pieces together. Wayne may be able to account for his whereabouts in some cases where Batman is known to have been involved, but if he shows up at the hospital every time Batman does his thing, that gets harder to explain. Similarly, a person who sues Wayne for unrelated reasons may well be able to get access to Wayne’s medical history, assuming it’s within the realm of permissible discovery. This could, in turn, lead to other connections being made and investigations started.  Hacking and other unintentional leaks are another way the information could become public. And like with WikiLeaks, once information is out there it’s hard to make it go away.

Third, there’s the issue of payment. Wayne is listed as self-pay, which is entirely plausible given his particular position. But what about Dick Grayson and Jason Todd? Or Selina Kyle? Or Frank Castle? Or basically any other more-or-less normal guy with a dangerous sideline, no healing factor, and a masked identity? How are they paying for their medical care? Insurance? Certainly not from their employers, and even if they were, that means that some claims adjuster out there is getting regular reports of outrageous physical trauma. Phone calls are going to be made. Self pay? Do these people even have jobs? If not, where are they getting the money for all of this? If they’re paying, someone is going to start asking how, and if they’re not, the hospital is going to start getting pissed. Again, attention, which is bad news for anyone trying to maintain a successful, secret alter ego. Field-medic-style first aid isn’t really a solution here, as even if our heroes never go to the hospital for the traumas they suffer, they’ll still probably wind up stopping in for something eventually, at which point even a minimal probing of their medical history or a cursory imaging study is going to reveal unexplained past injuries. Questions will be asked.

So good on Saunders for a plausible take on what a document like this would look like. It’s a valuable bit of added realism that comic book writers would do well to consider.

18 responses to “Batman’s Medical Records

  1. There is a panel from a Golden Age Batman where Bruce’s Doc (housecall, I assume) is stitching him up after Batman took a bullet in the shoulder. The Doc is asking how he could have shot himself while cleaning a gun when there is no powder burns. Bruce replies something to effect of doing crazy things and he’ll tell him about it sometime.

    That panel – while clearly from a whole ‘nother era in society AND comics – has always stuck with me for precisely the reasons you outline above.

  2. This has been a plot point in another Batman story too, but from a different angle. From memory, Batman catches Catwoman after she gets shot at a seedy underworld doctor’s surgery, and explains that he knew about its business-treating people who don’t dare go to a hospital-and has let it stay in business to catch criminals who come to it. Of course the downside is that their records probably won’t have names attached, so you’d have to follow them when they leave the surgery…

  3. I find it strange that Batman would go to the hospital instead of retaining a private medical staff keeping all medical records under his personal control.

    I really do like the comment about the fact that given his MMA club practices any alternative would probably be safer.

    • The author may not be aware of Leslie Thompkins’ role in Bruce’s backstory as both personal physician and unofficial foster mother, at least not when the report was worked up. Leslie’s own version of the report would be considerably more to the point.

      • Oskar Sigvardsson

        And lets not forget about Alfred: the man is a trained medic and has even performed surgery on Batman a few times. I don’t think Bruce Wayne goes to a hospital if it’s not for extremely serious (i.e. back-breaking) injuries or Wayne Corp. mandated physicals.

      • Unless Alfred has the equipment and training to take scans of a head and check for internal bleeding, damage from frostbite or exotic poisons sooner or later Wayne needs to get to a hospital. Admittedly Wayne’s wealth and history might keep suspicions of vigilante activity off of him but he has to rely on at least one doctor (and probably an entire team really) to keep their mouth shut and not do something stupid like attempt blackmail.

  4. In the Marvel U, Night Nurse treats masked patients free of charge. Reed Richards and Dr. Strange are also known to contribute to the more… Exciting cases.

    One assumes similar arrangements exist in the DCU, whether arranged by the Justice League/Society (Dr. Midnite). Also, it’s firmly established that Alfred treats most of Batman’s injuries (and, one further assumes, Dick, Tim, Damian and even Selina might use his services).

  5. For Batman in specific, these sorts of articles tend to neglect that Bruce Wayne is *rich*. Rich people can go to doctors who are discrete, and place a higher than standard value on confidentiality. Wayne in particular can also spread some money around to make sure his records don’t match Batman’s injuries, either removing some data, or adding some false incidents. Also, I would have thought that the records would have a note about possibly being driven to engage in dangerous activities due to unresolved psychological trauma from parent’s murder. Remember, the Wayne murder is not secret (the opposite – part of Gotham lore) so anyone reading those records is likely to think “Poor guy, engaging in self-destructive behavior due to what happened to him as a kid, an adrenaline junkie ” instead of “He must secretly be *Batman*!”

    Dick Grayson is also rich, has some of Bruce Wayne’s money, probably same doctors, same sorts of explanations.

    Frank Castle uses money he takes from criminals, and likely knows doctors who keep their mouth shut. He can say he’s a “security consultant” for select private clients, who pay in cash. If anyone asks, he got hurt fighting burglars in his home, prove it didn’t happen.

    Selina Kyle does whatever crooks do – not so great services there.

    But even in the real world, many people have past injuries from domestic abuse or fighting without being superheroes. For example, Selina Kyle can just say “I had a bad past with a man who beat me extensively, but it’s all over now and I don’t want to talk anymore about it, brings up terrible memories”. Frank Castle says “I’m an ex-marine and private consultant to security forces in high-risk areas, and I’ve got the scars to prove it. If you want to know how to stay alive, learn from a man many people have tried to kill.” (heck, this could even evolve into a decent cover if he cared – he could hand out business cards about “Castle executive security services”).

    Given the state of social services, I doubt anyone is going to care too much about further investigation, unless it’s part of some larger political agenda (in which case it’s part of a bigger problem).

    • I’m inclined to agree. For some of the comic book characters, this is likely to be a big problem (Rorschach comes to mind), but many characters in the comics would have ways of dealing with this, even if the comics rarely go in depth. I have often thought Batman would be more believable if he were depicted as having a moderately-large support staff, many of which would be privy to his real identity, to directly help with things like maintaining his cover, providing his personal medical care, providing intelligence collection and analysis, etc. He would have the resources to arrange it.

      But even without arranging something like that, it is fairly plausible to maintain contacts with doctors that won’t ask questions, won’t keep records. Evidence of old injuries can easily be explained by dangerous hobbies.

      While this will likely become less common as E-records are implemented, my own medical records at my primary care doctor are highly fragmented and far from a complete story simply because I have moved around frequently in my life. Someone who has both a reason and resources to make sure their medical records where fragmentary and incomplete would not likely have too much of a problem. And as Seth points out, once you have a superhero (or supervillain for that matter) community, they will likely have ways (depending on the continuity, possibly highly exotic ways unavailable to general public) of taking care of their own, without records.

  6. You have to wonder what Dick Greyson’s medical record said, especially as a kid when he was Robin and getting hit on the head a lot. Since he was adopted there should have been some sort of care worker keeping an eye on him, obviously they were sleeping on the job.

  7. As “Bytowner” pointed out above, in some versions, Dr. Leslie Thompkins (the woman who found Bruce just after his parents’ murder) fills the role of Batman’s “medical support staff.” In the post-Crisis comics and in the Animated Series continuity, she knows his secret identity and is called in when he needs serious medical treatment, or else he goes to her clinic if he gets injured in the field. Leslie runs the Thomas Wayne Memorial Clinic, funded by Bruce, and while this is largely a genuinely philanthropic enterprise — part of Bruce’s efforts to try to make Crime Alley a safer place — it’s also Batman’s way of ensuring his own access to confidential medical care and the necessary equipment and supplies for same. Since Bruce himself is Leslie’s employer and provides the funding for her clinic, there aren’t any awkward questions raised about all the medical supplies she needs to use up to tend to Batman’s health. I’m not sure if this is still true in the new DC continuity, though.

    On the issue of company-mandated physicals, I often wonder how Clark Kent deals with those at the Daily Planet.

    As for the Punisher, he doesn’t really fit this discussion, because he doesn’t have a “civilian” identity — no address, no job, no pretense of normality. The authorities (and other superheroes) know that Frank Castle is a wanted felon and fugitive, and he pretty much lives his whole life underground. The Punisher’s issues with health care would be more along the lines of a typical villain’s. If he went to a hospital, he might find himself under arrest.

  8. From the original:
    “(Note to clerical staff — please exclude the following note if there are future record requests.”

    Is this allowed?

    • Depends on who’s doing the requesting and the laws of the jurisdiction. If it’s part of discovery in a civil or criminal suit and the medical file is discoverable evidence (e.g. it’s not a contract dispute or something else where Wayne’s medical file is irrelevant), then the requestor will get the whole file because there’s no evidentiary privilege that would protect it.

      • Unless the follow portion is destroyed, or lost. Nothing says that Bruce Wayne’s medical records don’t regularly get lost for some reason.

  9. Following the Clark Kent response above…

    What if he doesn’t have company-mandated physicals and has literally never seen a doctor, and so has no medical or dental file?

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