Improper use of social media can lead to invasions of privacy

New technologies are accomplishing amazing things in healthcare. Social media tools, for example, are being used by providers and families to coordinate care; Facebook, Yammer, and Twitter are also keeping the public informed about new medical techniques, hours of service, wait times and more.

But there are always some who misuse new technologies. One such example occurred last year in Prince Edward Island, when a nursing-home worker was fired after posting a photo of a dead resident on Snapchat and forwarding it to a friend.

Apparently the worker, who was employed at the Margaret Stewart Ellis Home in O’Leary, PEI, had shared multiple “inappropriate and degrading photos and videos of vulnerable residents while they were eating, sleeping, using the commode and when … co-workers were providing personal care to certain residents after a bowel movement.”

Health PEI conducted its own investigation and spoke to more than a dozen employees at the facility, as well as to members of the community. When contacted by CBC News, the former employee claimed there was another side to the story but did not wish to speak to the media.

Documents obtained by the CBC show that the fired employee was not explicitly linked to the degrading social media posts that are at issue.

The Health PEI investigation, it seems, set out to determine how such actions took place and to come up with rules to prevent them in the future. The agency already had policies in place stipulating that employees are not to have personal communication devices, like cell phones, with them during work hours.

It discovered that employees were using electronic devices on the job, for talking and texting. And why not? The leading-edge thinkers are all touting the benefits of instant communication and tying circles of care together using electronic devices.

The cameras on phones are being suggested as the next great improvement – by including photos of patients or residents, caregivers will be able to see exactly who needs help during an alert; photos and videos can also be used to show the current health status of these patients – a still image or video can quickly demonstrate how far a patient has declined.

Of course, images can also be used poorly, to embarrass or disgrace patients and residents, as the incident in PEI shows.

Nursing home workers aren’t the only ones taking photos of patients and sharing them inappropriately – doctors are doing it, too.

For example, as his patient lay unconscious on a surgical gurney, a Victoria, B.C. urologist took out his smartphone and photographed the location where he’d just attached a urinary catheter. Then, as a “joke,” the doctor texted the image of his patient’s genitals to various friends and acquaintances. The ethical lapse ended up costing the specialist $20,000 in fines and a six-month suspension from medical practice in 2015, the National Post reported earlier this year.

In Prince Edward Island, the nursing home incident only came to public attention through the efforts of the CBC. Now, the privacy commissioner in PEI is calling on Health PEI to disclose more details.

According to Karen Rose, the commissioner, disclosure of this type of information will promote public safety. “The resulting transparency ensures that there is sufficient public knowledge of publicly operated community care facilities. In my view, such knowledge brings issues to the forefront, encourages discussions and spearheads changes, where necessary.”

In July, the commissioner gave Health PEI 40 days to prepare the information for release.

Meanwhile, the incident has exploded into a political issue, with the opposition Progressive Conservatives in PEI calling for the immediate release of details.

“Honestly, I don’t know why this file was not turned over to the RCMP for an investigation,” said opposition health critic James Aylward.

Aylward said it took a Freedom of Information request by the media for the breaches – which allegedly involved multiple photos and videos of elderly residents – to be brought to light.

“If pictures are being taken of either a deceased individual or a senior in a vulnerable circumstance and then shared publicly, fundamentally it is just wrong,” Aylward said.

He said there are still unanswered questions based on the media report, which did not connect an employee who was fired over the incident with taking the photo of the deceased resident.

“So if it doesn’t connect the person who was fired, then who was taking the pictures?” asks Aylward. “I want some kind of assurance here that the policies are being adhered to and that any other infractions that may have occurred have been dealt with accordingly.”

Aylward said a full audit needs to be done of long term care homes in the province, to probe further into privacy issues.

Healthcare workers misusing social media to post degrading photos of patients is a bigger problem than one might think.

The Pro Publica website, an independent source of information in the public interest, has been charting such invasions of privacy in the United States since the beginning of 2012. In that time, it has noted 47 cases of inappropriate social media posts by nursing home workers.

These include photos and videos of residents who were naked, covered in feces or even deceased. They also include images of abuse.

(See https://www.propublica.org/article/inappropriate-social-media-posts-by-nursing-home-workers-detailed)

And in early August, federal health regulators in the United States announced plans to crack down on nursing home employees who take demeaning photographs and videos of residents and post them on social media.

The Centers for Medicare and Medicaid Services, which oversees nursing homes, said in a memo to state health departments that they should begin checking to make sure that all nursing homes have policies prohibiting staff from taking demeaning photographs of residents.

The memo also calls on state officials to quickly investigate such complaints and report offending workers to state licensing agencies for investigation and possible discipline.

“Nursing homes must establish an environment that is as homelike as possible and includes a culture and environment that treats each resident with respect and dignity,” said the memo signed by David Wright, director of the CMS survey and certification group. “Treating a nursing home resident in any manner that does not uphold a resident’s sense of self-worth and individuality dehumanizes the resident and creates an environment that perpetuates a disrespectful and/or potentially abusive attitude towards the resident(s).”

CMS said that nursing homes have a responsibility to provide training on how to prevent abuse, and to investigate all allegations of abuse. If homes fail to do so, they can face citations, fines and theoretically even termination from the Medicare program.

Also in August, Sen. Charles Grassley, chairman of the Senate Judiciary Committee, called on other federal agencies to take action on the problem.

He sent letters to the U.S. Department of Justice and to the Office for Civil Rights within the U.S. Department of Health and Human Services asking whether “rules and protections are in place to prevent and punish these types of abuses.” He also has sent letters to social media companies, calling on them to pay more attention to this.

In Canada, the incident in Prince Edward Island may have national importance, as it’s one of the first instances of social media abuse in a nursing home to be publicized in this country. It may spark nursing homes and governments across Canada to be more vigilant about staff use of social media, and to educate employees more vigorously about privacy issues.