On Election Day in 2016, Dr. Judd Flesch, a pulmonologist at Penn Presbyterian Medical Center, found himself doing a job he never expected would be part of practicing medicine: Driving down the west side of Market Street on his way to City Hall with a box of completed emergency absentee ballots from unexpectedly hospitalized voters on his backseat.
According to Pennsylvania election law at the time, voters had to wait until 5pm to even apply to vote via absentee ballot, get a physician to sign it, and get it notarized. After that, someone had to argue before a judge that the patients qualified to vote via absentee ballot in the first place. That took hours, because the election lawyers had a lot of questions. Once approved, the voters had very little time to get their ballots, cast their votes, and get their ballots back to City Hall.
Flesch felt like he’d spent the day running around the city. A few hours after getting to Penn Pres for work, he’d left West Philly for Society Hill to cast his own vote. Then, he’d returned to the hospital and busied himself signing off on patients’ emergency ballot applications.
After all that, he and medical student Dorothy Charles hopped into his car and drove the ballots to City Hall. He remembers pulling up to the curb and watching Charles sprint past the Clothespin and across Dilworth Plaza, ballots under her arm, in a race to make the deadline. She delivered the last of the ballots by 7:56pm — four minutes before the deadline.
The whole experience was new for Flesch. “It was crazy, because it was kind of last minute,” he says. “But it was very empowering.”
That year, Flesch and Charles helped between 20 and 30 people vote. Today, that haphazard voting initiative first named Presby Votes has become the get-out-the-vote machine Penn Medicine Votes, helping people access emergency absentee ballots across Penn Medicine hospitals and promoting voter registration to healthcare professionals and patients. In 2020, 99 patients cast votes through this initiative, and civic-minded healthcare professionals at Penn talked with over 200 peers and patients about voting.
How do hospitalized people vote?
Flesch may be the man in charge now, but Charles provided the impetus for the project when she was a medical student. While shadowing an attending physician, Charles asked how patients were going to vote. That doctor didn’t know the answer, so he turned to Flesch, who is a hospital administrator, in addition to his pulmonary care work.
It wasn’t something Flesch had thought about, though he’s long been interested in politics and history. In his free time, he’s reading Team of Rivals, Doris Kearns Goodwin’s Pulitzer-winning Abraham Lincoln biography. He graduated from medical school in 2006, but for the next couple presidential elections — when patients tend to ask the most about their voting rights — he didn’t work in American hospitals.
In 2008, he was in Botswana doing a rotation for his residency — and preoccupied with getting his own absentee ballot. (He stayed up all night to watch the results come in; his husband, who was on a plane from Philly to visit, learned Obama won from the pilot.) When the 2012 election rolled around, he was doing a research fellowship and didn’t have much face time with patients.
“Voting affects your health. Every part of health can be on the ballot in some way.” — Quinlen Marshall
“I hadn’t been thrust into the situation where it would have been as front-of-mind,” he says. “Because [2016] was Dorothy’s clerkship rotation, and there was so much in the news about the election that year, it was really front-of-mind for her. And I was really glad that she brought it to our attention.”
The first year was chaotic in part because they started late, but mostly because Pennsylvania used to have an onerous emergency absentee ballot process. (It’s much better now, which I’ll explain later.)
In 2016, Charles ended up arguing their case before the judge, though she had no legal expertise. “There was some back and forth among the election lawyers, and it took a couple hours,” Flesch says. She was ultimately successful. The judge approved every single application. But the sprint to get the ballots to City Hall in time made Flesch realize the team needed more help if they were going to continue this in the future.
By the next election, he’d partnered with Penn’s law school to recruit student volunteers who could argue before a judge. Steve Cobb, Penn’s director of government relations, connected him with Director of Ethics at the Hospital of the University of Pennsylvania Aliza Narva, who was running a voter registration program for staff and patients at the Hospital of the University of Pennsylvania (HUP). Flesch and Narva teamed up to create Penn Medicine Votes and still lead the program together.
Get out the vote at Penn
If you’ve been to a Penn Medicine hospital or office for a check-up lately, you might have seen doctors wearing badges on their lanyards with QR codes and a question: Are you registered to vote? Flesch holds his badge up to show me during our Zoom. Of course, they’re red, white and blue.
Scan that and it’ll bring you to the state’s voter registration portal. You can sign up or update your status right away, no matter if you’re in the ER, waiting for the OR or just getting a physical. The badges have tips for helping providers talk about voting with patients in a nonpartisan way.
To further spread the word, Penn Medicine equipped cafeteria trays with flyers promoting voter registration. On Election Day, hospital TVs provide instructions for how patients can request emergency absentee ballots.
The efforts are two-pronged: Get everyday people to register, and help unexpectedly hospitalized people exercise their voting rights on Election Day.
The voter registration efforts are spread across Penn’s hospital system, including out-patient facilities. Individual care providers can elect to participate by dining a badge or initiating conversations about voting with patients. Today, for National Voter Registration Day, they have tables set out across the hospital system and in the medical school, encouraging doctors, nurses, patients, basically anyone in the hospital to register to vote.
“Probably our most effective method is that we put flyers on cafeteria trays,” Flesch admits. Everyone has to eat, after all.
Penn concentrates its Election Day efforts in fewer spots: HUP, Presby, The Benjamin Franklin-founded Pennsylvania Hospital in Old City, HUP Cedar, Lancaster General and Penn Medicine Rittenhouse. On November 5, volunteers will help patients check their voter registration status and fill out emergency absentee ballot applications.
Another team brings the emergency absentee voter applications to City Hall, gets them processed, and returns with ballots. Thankfully, they no longer have to argue before a judge or have notaries and physicians sign off. 2019’s Act 77, which expanded mail-in voting in PA, also simplified the emergency absentee ballot application process. Patients still must sign an official slip authorizing Penn’s volunteers to transport their ballots to City Hall.
Once ballots are filled out and sealed, Penn medical school volunteers bring them to City Hall before the 8pm deadline so that the votes can be counted. Patients who don’t live in the city can opt to have family members pick up and drop off ballots; Penn Medicine Votes volunteers still help them with the process.
If you’ve been to a Penn Medicine hospital or office for a check-up lately, you might have seen doctors wearing badges on their lanyards with QR codes and a question: Are you registered to vote?
The initiative has a core leadership team of about ten people and what Flesch describes as a “large army” of Election Day volunteers (50 so far). But “anybody that has credentials to be in the hospital and interface with patients can volunteer,” he says.
For Quinlen Marshall, a second-year med student at the University of Pennsylvania Perelman School of Medicine, volunteering with Penn Medicine Votes combines his passions for both medicine and civic engagement.
Growing up in St. Cloud Minnesota, he remembers being part of a civically engaged community. (Minnesota, had the highest voter turnout of any state in 2020). His parents took him to watch them vote when he was a child and he was part of the Eugene J. McCarthy Center for Public Policy and Civic Engagement whilst an undergrad at St. John’s University. Volunteering as one of three medical student coordinators with Penn Medicine Votes helps him feel like he’s continuing his civic engagement efforts, while empowering patients.
“When you’re in the hospital for a long time, it’s easy to get bored, and it’s easy to get it to feel like you’re spinning your wheels. [Penn Medicine Votes] helps them become civically engaged, but I think it also just gives them a bit of purpose,” Marshall says. “Giving people a little sense of agency in a really hard time is special.”
“Healthcare is on the ballot”
Penn Medicine Votes is one of several programs, both local and national, that help patients exercise their voting rights whilst hospitalized.
A national nonprofit called Vot-ER helps hospital systems like Penn’s teach providers how to discuss voter registration with patients in a nonpartisan way. Temple’s Office of Patient Experience has helped hospitalized patients vote via emergency absentee ballot since 2016, though their efforts reached fewer patients than Penn’s. (Five people voted via emergency absentee ballot in their first year.) Vot-ER estimates their initiatives have reached 89,000 voters. Thirteen percent of people who did not vote in 2020 cited health issues as the reason they could not make it to the polls, per Census Bureau data.
These initiatives are taking off in part because a lot of physicians feel that healthcare is on the ballot — literally. In some states, voters have decided on women’s reproductive rights. Legislators continue to debate the future of the Affordable Care Act. Issues such as healthcare costs, gun violence and health insurance all influence the decisions voters make at the polls — or in their hospital beds.
“Voting affects your health,” Marshall says. “Every part of health can be on the ballot in some way.”
Some people might say helping patients vote is beyond the scope of care doctors are meant to provide. They should focus on saving lives, not the ballot box, the argument goes. To Flesch, helping patients vote is part of the job — and a satisfying part of it. He saves people everyday in his job, but he tells me that he has never seen patients appreciate something as much and as universally as when he brings them a ballot.
“Any number of patients to whom I’ve brought an application or a ballot have been like, this is so wonderful. I didn’t think I was going to get to vote. This is really important to me. Thank you for this effort,” he says.
Corrections: Steve Cobb is Penn Medicine’s government relations director. Aliza Narva is Director of Ethics at the Hospital of the University of Pennsylvania.
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