# pictures of patient posted by RNs



## firecoins (Feb 26, 2009)

Well this topic doesn't seem to get old.  

http://www.wisn.com/cnn-news/18796315/detail.html

2 RNs posted pictured of a sex object lodged in a man's rectum on their facebook.  Apparently no faces or names but still not a good situation.


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## Jon (Feb 26, 2009)

Timeout - Story says they might or might not have posted photos online, or just had photos and discussed the situation. Still - not a bright idea.


It will be intresting to see what happens when the dust settles.



Jon


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## VentMedic (Feb 26, 2009)

Our hospital and flight teams have a NO TOLERANCE policy. PERIOD.  You disclose NOTHING about the patient.   If anything is to be disclosed it will go through the proper channels by way of the patient, physicians, PR department and legal team.  

That X-ray is part of the medical record.  If this is found to be a violation of laws either Federal and/or State and the hospital as well as the RNs face a stiff monetary penalty. These nurses will be lucky to find a decent hospital job in the U.S.   Of course, some may cut them some slack in that the punishment and publicity will be enough for them to have learned a valuable lesson.

Patients come to us when they are most vulnerable and have an expectation of privacy.   A trust has been broken here even if it is found no laws are violated.


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## Shishkabob (Feb 26, 2009)

From the story alone, I don't see how it's a possible violation of HIPPA considering no identifying pt info was released / known.

Best decision ever?  Nope.  But I'm sure many, if not most,  people here have taken a pic of something totally ridiculous while still following the guidelines.


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## VentMedic (Feb 26, 2009)

Linuss said:


> From the story alone, I don't see how it's a possible violation of HIPPA considering no identifying pt info was released / known.


 
HIPAA.  Sorry...uncontrollable impulse to correct.

The X-Ray is part of a medical record that must have a release signed.   Every X-ray also has the patient identification on it.  If any part of that was captured in the photo, there will be several laws violated.


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## Jon (Feb 26, 2009)

VentMedic said:


> HIPAA.  Sorry...uncontrollable impulse to correct.
> 
> The X-Ray is part of a medical record that must have a release signed.   Every X-ray also has the patient identification on it.  If any part of that was captured in the photo, there will be several laws violated.


How would an image of a PART of an X-ray be PHI? so long as there isn't Pt. identity info in the captured section, then I don't see how HIPAA would be breached.


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## JPINFV (Feb 26, 2009)

I think it needs to be repeated.

DO NOT SET YOUR MYSPACE/FACEBOOK PROFILE TO PUBLIC IF YOU POST ANY THING THAT IS EVEN POSSIBLY COMPRISING OR UNPROFESSIONAL TO IT. THIS INCLUDES FUNNY PICTURES TAKEN AT WORK OR PARTY PICTURES.


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## JPINFV (Feb 26, 2009)

Jon said:


> VentMedic said:
> 
> 
> > HIPAA.  Sorry...uncontrollable impulse to correct.
> ...



Emphasis added.


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## VentMedic (Feb 26, 2009)

Jon said:


> How would an image of a PART of an X-ray be PHI? so long as there isn't Pt. identity info in the captured section, then I don't see how HIPAA would be breached.


 
That medical record still belongs to the patient.  Even when we use "part" of an X-ray for teaching, the patient signs a release at sometime or is advised that their information may be used for data collection, education and research...not FACEBOOK.


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## AJ Hidell (Feb 26, 2009)

The question here has nothing to do with HIPAA.  This is about ethics.

Ethics are practiced when you do the right thing, even when it isn't written in policy.

HIPPA SCHMIPPA.  Do the right thing every time.  Don't sit around and try to find excuses to do otherwise.  Situational ethics are not ethics.


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## karaya (Feb 26, 2009)

Vent is right, this is considered a breech of the patient's records. This is not new with hospitals. Some of you may recall the George Clooney incident back in 2007, whereby his identifiable medical information was leaked to the media after dozens of hospital employees obtain access to his records. This was after he was treated at the hospital as a result of a motorcycle accident. Dozens of employees including doctors and nurses were suspended as a result.

George Clooney himself went public and pleaded with the hospital not to suspend the employees and a representative from HIPAA went on record and she stated that she felt the hospital "over reacted". HIPAA, since its enactment, has taken a self regulatory position in a lot of privacy cases, preferring that medical providers identify security breeches and take measures to correct as well as improve privacy education and seal up security holes.

What may be of interest in this case is were the nurses directly involved with the care of this patient?  Was the x-ray properly secured or was it left on display for everyone to chuckle about?  

Which brings me to my point about this incident. It is uncertain if any identifiable health information was made public on the nurse's web sites. And that is a matter we may never find out. But, as a result of the nurses intentional and reckless actions, they have brought embarrassment to the hospital as well as having to face ridicule and potentially destroyed careers.


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## VentMedic (Feb 26, 2009)

karaya said:


> Vent is right, this is considered a breech of the patient's records. This is not new with hospitals. Some of you may recall the George Clooney incident back in 2007, whereby his identifiable medical information was leaked to the media after dozens of hospital employees obtain access to his records. This was after he was treated at the hospital as a result of a motorcycle accident. Dozens of employees including doctors and nurses were suspended as a result.


 
Whenever we log into a computer system, our identity and whatever files we access are recorded.  If we have no business in those files, we will have to answer to the powers that be.  As an RRT who can be anywhere in the hospital at any given moment assessing patients, I must be careful to show documentation of every "intent" I have when I gain access to a file.  As I have mentioned before, my hospital system handles many high profile cases.  Any breech of security will have our electronic signature on it. 

However, this senario is slightly different in that instead of just having a looksy on the computer into the medical records, they copied the medical record to post for their own amusement.


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## VentMedic (Feb 26, 2009)

For those of you in California, although other states have similar laws:

http://news.idg.no/cw/art.cfm?id=D8E624BE-17A4-0F78-3178D219582E8AB2



> SB 541 specifically requires covered businesses, such as licensed clinics, health facilities, home health agencies and hospices, to implement physical, technical, administrative and procedural safeguards for preventing unauthorized and unlawful access to patient data and monitoring employee access to the data. The new law gives the CDPH authority to impose fines of up to $25,000 for each patient whose medical information may have been accessed, used or disclosed in an unauthorized manner.


 


> The change in terminology means that health care organizations will need to implement controls not just to protect information from malicious outsiders, but also to guard against misuse of data by employees who have access to systems as part of their job responsibilities, MacKoul said.


 
Since many X-rays are also digital, this will not only apply for a patient record but also as internet/intranet security.


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## Ridryder911 (Feb 26, 2009)

There is a current case involving a teen and a accident this last week. Very graphic and strange. Unfortunately, someone took great scene pics. These would have been great teaching tools if used properly. The problem is that it leaked into the internet and yep... you guessed, apologies have been made and of course the ".. no comment at this time"....

R/r 911


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## AJ Hidell (Feb 26, 2009)

Rid, do you know if there was any fallout from the scene photos from Tulsa, where the guy on the crotch rocket hit the semi?  Of course, dead bodies are not patients and do not enjoy the same legal protections.  But I am curious if any ethical sanctions were taken in that case.


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## Ridryder911 (Feb 26, 2009)

I never heard of any pending problems, as alike you described it was a DOA even though the Internet rumors described he was alive. 

Here is a link for the new problem.  http://www.kfor.com/news/local/kfor-news-okc-fire-dept-photos-story,0,5492850. I received the pics (no not on a porn site ) and I will admit they were in detail and not off a cell phone. The call was unique and I wanted to post about it when it occurred, but due to the confidential I refrained. A personal friend of mine worked it and I will say they did an outstanding job. He is unsure who took the pics or not talking (yes, he is a smart medic)


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## ffemt8978 (Feb 26, 2009)

Ridryder911 said:


> I never heard of any pending problems, as alike you described it was a DOA even though the Internet rumors described he was alive.
> 
> Here is a link for the new problem.  http://www.kfor.com/news/local/kfor-news-okc-fire-dept-photos-story,0,5492850. I received the pics (no not on a porn site ) and I will admit they were in detail and not off a cell phone. The call was unique and I wanted to post about it when it occurred, but due to the confidential I refrained. A personal friend of mine worked it and I will say they did an outstanding job. He is unsure who took the pics or not talking (yes, he is a smart medic)



Linky no worky...


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## Ridryder911 (Feb 26, 2009)

http://www.kfor.com/news/local/kfor-news-okc-fire-dept-photos-story,0,5492850.story

Try this


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## ffemt8978 (Feb 26, 2009)

That one works.  Thanks Rid.


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## medic417 (Feb 26, 2009)

Ridryder911 said:


> http://www.kfor.com/news/local/kfor-news-okc-fire-dept-photos-story,0,5492850.story
> 
> Try this



Works.  I hate that if you put a period at the end it messes up links.


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## Aidey (Feb 26, 2009)

Hmm....

I agree that the nurses behavior was totally unethical, and inappropriate and firing them was probably the best move. 

However, if the x-rays did not have any identifying information on them that could identify the person, hospital, date etc then I don't think they should be prosecuted. 

I see a bit of a slippery slope here when it comes to using things like EGKs, X-Rays, CT scans etc for education purposes. When I was a MICP student we had to do case studies, and we never obtained permission from the patient when doing these studies. The only requirements were that the patient was someone we had direct interaction with, and we had to scrub the medical records of everything but age and gender before removing them from the hospital. 

My concern is that things used for educational purposes could be caught up in regulations aimed towards preventing things like this from happening.


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## VentMedic (Feb 26, 2009)

For those in Florida, here is a review of patient privacy laws and statutes regulating access to medical records:
http://www.flsenate.gov/data/Publications/2005/Senate/reports/interim_reports/pdf/2005-142he.pdf


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## VentMedic (Feb 26, 2009)

Aidey said:


> However, if the x-rays did not have any identifying information on them that could identify the person, hospital, date etc then I don't think they should be prosecuted.


 
I believe you will find a quote similar to this, although the penalty may vary, in many hospital policies even though this one is taken directly from the CA link I posted earlier.



> The new law gives the CDPH authority to impose fines of up to $25,000 *for each patient whose medical information may have been accessed, used or disclosed in an unauthorized manner. *


 
Your school may have an educational permit to access information. However, watch how fast that privilege disappears if someone was to use their cell phone to photograph actual documents and patients in the hospital.


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## MMiz (Feb 28, 2009)

*Nurses Take Cell Phone Pictures of Patient - Case Referred To FBI*

*Nurses Fired Over Cell Phone Photos Of Patient*
_Case Referred To FBI For Possible HIPAA Violations_

LAKE GENEVA, Wis. -- Nurses accused of photographing a patient and posting the pictures on the Internet have been fired.

The investigation started with an anonymous call from an employee at Mercy Walworth Medical Center in Lake Geneva, with the allegation that a nurse took pictures of a patient with her cell phone and posted them on her Facebook page.

The patient was admitted to the emergency room with an object lodged in his rectum.

*Read more!*


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## medic417 (Feb 28, 2009)

Someone posted about this on here the other day if I recall correctly.
\
Here it is.  http://www.emtlife.com/showthread.php?t=11520


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## MMiz (Feb 28, 2009)

Oops, didn't see that one.  Thanks.


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