Implementation of a Medical Student-Led Emergency Absentee Ballot Voting Initiative at an Urban Tertiary Care University Hospital


Kathryn Linder, BS1#, Alisha Maity, BA1#, Madeleine Becker, MD2, Gregory Kane, MD3, 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 2Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA , 3Department of Medicine, Thomas Jefferson University, Philadelphia, PA


Medical and allied health professionals are in a unique position to advocate for vulnerable patients. Students at Thomas Jefferson University Hospital (TJUH) launched an emergency absentee ballot voting initiative for the 2018 election, affording hospitalized patients (and their family members/support persons) the opportunity to vote despite acute hospitalization. This program sought to enable voting by absentee ballot for those with unexpected hospital confinement and absence from voting municipalities after the absentee ballot deadline passed. Recently, other medical institutions enacted nonpartisan voter registration and ballot activities in residency clinics, through hospital volunteer services, or with support of attorneys and law students. Our inaugural program, in contrast, was successfully initiated and led by undergraduate medical trainees.


Over the week before Election Day 2018, our interdisciplinary team of 50 medical student volunteers visited patients and caregivers at TJUH, assessing their interest in bedside voting via emergency absentee ballots. Hospital staff also directed volunteers to interested patients. We serviced Pennsylvania registered voters in Philadelphia County and neighboring Delaware, Montgomery, and Bucks Counties. The effort was nonpartisan; candidate or party-specific materials were strictly prohibited. Both a notary public and a physician were required for this process. A notarized affidavit was generated for each interested constituent, and physician sign-off affirmed hospitalization as the reason for an inability to vote in person. We submitted notarized absentee ballot applications to the Board of Elections (BoE). Ballots were issued upon application approval. Student volunteers distributed ballots to patients and aided in their completion by providing instructions, and reading text aloud, if necessary. Students collected and returned ballots to appropriate county election offices before the statutory deadline. HIPAA-compliance was assured using a spreadsheet tracking participants' room locations and stages within the application process.


During the statewide timeframe, students visited over 500 patient rooms throughout our academic urban hospital. In total, our team submitted 92 ballots primarily to the Philadelphia County BoE in addition to three surrounding counties. All eligible individuals would likely have been otherwise unable to vote during these midterm elections. Responses from patients and their families, house staff and hospital personnel were overwhelmingly positive.


Hospitalized patients may not anticipate needing absentee ballots on Election Day. A medical student-driven hospital-wide voting initiative assisted inpatients in voting via emergency absentee ballots; such a program integrated civic engagement in patient care. Our program could be replicated at other academic centers with hospital support and student leadership. A key resource is access to certified notaries so that ballot applications can be authenticated. Many states have voting provisions allowing those hospitalized to participate; however, widespread education about state-specific requirements is necessary. Well-organized emergency absentee ballot voting programs promoted in hospitals can allow vulnerable hospitalized patients to vote in local and national elections.


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