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An investigation by ProPublica has revealed widespread abuse of patient privacy, and dignity, by workers from nursing homes and assisted living facilities across the country.
Nursing facility workers have taken embarrassing photographs of patients and have shared them on social media websites such as Snapchat. Some of the photographs and videos that have been shared by nursing facility workers show physical and mental abuse of patients suffering dementia.
The ProPublica review uncovered 22 cases of HIPAA-violating photo and video sharing that had been reported since 2012, with 35 instances of inappropriate image and video sharing found in total. Some cases involved workers taking photos of naked or semi-naked patients and posting them on Snapchat, others involved humiliating and degrading videos of patients. Once case involved residents being coached to sing “I’m in love with the coco,” while one held a banner saying “Got these hoes trained.”
Inhuman treatment and violations of patient privacy and dignity
The cases show widespread abuses of patient privacy, with the victims degraded and humiliated via social media websites. Snapchat was one of the most commonly used sites for the sharing of images. Photos have appeared for just a few minutes before disappearing with no trace, making it hard to determine the extent to which the practice is occurring.
It is therefore not clear whether the taking and sharing of images and videos is a growing trend, although 22 cases have been uncovered during the past two years, compared to just 13 before that. Some cases have resulted in employees being fired, some in criminal charges being filed against the workers responsible, but others have gone unpunished. Many cases may well have gone unnoticed.
Abuse of the elderly in nursing homes and assisted living facilities is nothing new. There have been numerous cases of patient abuse recorded over the years; however, the use of social media websites to publicize these acts is a new phenomenon. Images can be quickly and easily shared with others, but in many cases a permanent digital trail is left. This allows law enforcement to take action against the individuals concerned, if complaints are filed.
The review of cases conducted by ProPublica involved a search of government inspection reports. Some cases had been uncovered by the nursing homes and assisted living facilities, others by members of staff or by the community. Many have only come to light when individuals who have been sent the photos and videos have reported the incident to the nursing facilities. In most cases, photos and videos are not shared publicly, only with a small, closed group of individuals.
It is probable that there are far more cases than the 22 discovered, as not all would have been reported and investigated. In many cases the patients themselves would not have been able to complain as they were suffering from dementia or other serious mental health issues.
Photo Sharing Violated the Health Insurance Portability and Accountability Act
Patients and residents alike would be horrified and deeply distressed to discover degrading and humiliating images had been shared on social media websites. Some were embarrassing, others showed serious abuse. All involved an invasion of patient privacy and violated the Health Insurance Portability and Accountability Act Rules on data sharing. HIPAA prohibits the sharing of Protected Health Information without patient consent and the definition of Protected Health Information includes photographs of patients.
The cases included the sharing of “inappropriately exposed” patients and in some cases individuals who “appeared to be deceased.” One case involved workers at Gridley Healthcare and Wellness Center in California, and resulted in five workers being fired. They later plead guilty to state charges of elder abuse.
In Erie County, NY, a nursing aide was arrested for taking a photograph of an incontinent patient on a Smartphone and sharing the image on Snapchat. Edward J. Melock was sentenced to one year conditional discharge and was required to serve 100 hours of community service.
Former Indiana nursing assistant Taylor Waller took a photograph of a patient’s naked buttocks and posted the image on Snapchat. For the offense, classed as voyeurism, she served 3 days in jail. However, she failed to appreciate the severity of the incident claiming it had been blown out of proportion, saying it was “just a picture of her butt,” and that the image was not taken and shared with malicious intent.
Some cases were much more disturbing. One government inspection report revealed staff at the Autumn Care Center in Newark, Ohio, were found to have taken a video of cognitively impaired patients who had been trained to sing degrading song lyrics. The video was then distributed via Snapchat. The act was deemed to have resulted in “intentional humiliation” and “psychological harm” being caused. In total, six residents were reviewed for abuse at the facility.
That incident led to employees being fired and stricter policies being introduced covering social media and personal device usage.
Centers for Medicare and Medicaid Services and Office for Civil Rights Respond
The U.S. Centers for Medicare and Medicaid Services is addressing the issue by revising its definitions of abuse, neglect and exploitation to cover the taking of photographs and sharing of data on social media websites.
OCR deputy director for health information privacy, Deven McGraw was outraged when alerted to the instances by Propublica, and was reported as saying “If we don’t have pending investigations on any of these cases. . . they would be candidates for further inquiry from our end.” She also agreed that there was a need for new guidance on social media usage.
These are fortunately isolated incidents. The majority of nurses and healthcare workers provide a very high standard of care, and the nursing facilities in which they work usually take prompt action when any cases of abuse or mistreatment of patients occurs. Many implement a ban on the use of personal devices at work, yet those bans can be difficult to enforce, and instances of abuse can be difficult to detect.
There is clearly a need for new HIPAA guidance to be issued covering the privacy issues surrounding the use of social media sites. Since the use of social media sites is pervasive, and sharing of photos and videos so common, it is essential that this issue is discussed in specific terms with all nursing facility workers. Some care facility workers may not appreciate that the talking of photos or videos and posting them on social media sites is a HIPAA violation, and could potentially result in a jail term and heavy fine.
Nursing facilities should take proactive steps to prevent this type of abuse, and must enforce strict rules covering the use of personal devices in the workplace. There will always be instances when employees break the rules. When cases are uncovered, the individuals concerned must face the consequences, which should in many cases, involve criminal charges being filed.