Author Topic: S/O Gross/unethical pictures  (Read 4001 times)

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Mopsy428

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Re: S/O Gross/unethical pictures
« Reply #15 on: August 21, 2010, 06:42:23 PM »
Are you sure she didn't get the picture from a medical Web site or her old patho textbook?

OK. I shortened the quote just a bit. She wrote, "This is a _____ which we just took from one of our patients."

Rohanna

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Re: S/O Gross/unethical pictures
« Reply #16 on: August 21, 2010, 07:08:30 PM »
Just report it to facebook- they'll just remove the offending image, and maybe get it through to her that at least someone on her friends list doesn't want to see it.

If it was a random internal bit/external bit/critter... (ick) with no identifying patient information on it, and no patient in the shot- it's not "really" a privacy breach, unless the HC worker has a very, very small patient base and it would be obvious who's it was. It might be "technically" one- but really, no one is likely to look at that shot and say- "Hey, that's Bob's spleen! I didn't know he was sick". Plenty of medical textbooks and articles use such pictures, and they are completely "non-identifying".  It's like I can't post on FB.... "I saw Bob today, and man does he have terrible track marks", but I can say "I get a lot of patients with bad track marks, and it makes taking their blood hard".

Now if you could see the patient's face or external body parts it would be a different story...
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DangerMouth

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Re: S/O Gross/unethical pictures
« Reply #17 on: August 21, 2010, 07:12:58 PM »
I agree. While the pic sounds gross, I can't see how that would violate someone's pricacy.

M-theory

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Re: S/O Gross/unethical pictures
« Reply #18 on: August 21, 2010, 07:23:06 PM »
Are you sure she didn't get the picture from a medical Web site or her old patho textbook?

OK. I shortened the quote just a bit. She wrote, "This is a _____ which we just took from one of our patients."

That being the case, I agree with reporting her to the facility immediately without informing her. The photos that are occasionally taken as part of procedures are part of the confidential medical record covered by HIPAA, and distributing them to anyone unauthorized is a huge no-no whether or not there's any identifying info in the pictures themselves.

I wouldn't bother saying anything to her, because that will probably just make her more careful. And she needs to be punished for what she's already done.

M-theory

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Re: S/O Gross/unethical pictures
« Reply #19 on: August 21, 2010, 07:25:08 PM »
Just report it to facebook- they'll just remove the offending image, and maybe get it through to her that at least someone on her friends list doesn't want to see it.

If it was a random internal bit/external bit/critter... (ick) with no identifying patient information on it, and no patient in the shot- it's not "really" a privacy breach, unless the HC worker has a very, very small patient base and it would be obvious who's it was. It might be "technically" one- but really, no one is likely to look at that shot and say- "Hey, that's Bob's spleen! I didn't know he was sick". Plenty of medical textbooks and articles use such pictures, and they are completely "non-identifying".  It's like I can't post on FB.... "I saw Bob today, and man does he have terrible track marks", but I can say "I get a lot of patients with bad track marks, and it makes taking their blood hard".

Now if you could see the patient's face or external body parts it would be a different story...

They aren't the same.

Pictures legitimately taken in a healthcare setting are part of the patient's sealed record. The pictures in medical textbooks have been released by patients or their families, or are from autopsies.

Rohanna

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Re: S/O Gross/unethical pictures
« Reply #20 on: August 21, 2010, 07:31:27 PM »
Q: Are pictures considered part of the patient's health record/PHI, and am I able to disclose them?
A: Yes, pictures of the patient are considered part of their health record. You are able to disclose them in the same manner as other types of PHI are disclosed. A patient's photograph that identifies him/her cannot be posted in public areas, such as hallways, without specific authorization from the patient. Likewise, a patient's photograph that identifies him/her cannot be used in any form of publication without the patient's specific authorization. If the patient is not identifiable from the image, it is not considered to be PHI.


http://www.uthscsa.edu/hipaa/FAQs.asp

Now, the HC provider may be violating her own workplace policy on such photos- and as such could be at risk of a firing for that offence, but it would not as such be a HIPPA violation. This is assuming the OP is in the US- as in Canada and other countries different laws would apply.
« Last Edit: August 21, 2010, 07:34:43 PM by Shu »
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M-theory

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Re: S/O Gross/unethical pictures
« Reply #21 on: August 21, 2010, 07:37:46 PM »
Q: Are pictures considered part of the patient's health record/PHI, and am I able to disclose them?
A: Yes, pictures of the patient are considered part of their health record. You are able to disclose them in the same manner as other types of PHI are disclosed. A patient's photograph that identifies him/her cannot be posted in public areas, such as hallways, without specific authorization from the patient. Likewise, a patient's photograph that identifies him/her cannot be used in any form of publication without the patient's specific authorization. If the patient is not identifiable from the image, it is not considered to be PHI.


http://www.uthscsa.edu/hipaa/FAQs.asp

Now, the HC provider may be violating her own workplace policy on such photos- and as such could be at risk of a firing for that offence, but it would not as such be a HIPPA violation. This is assuming the OP is in the US- as in Canada and other countries different laws would apply.


From AHIMA:

In facilities where patient photography is used routinely to document patient care, the practice of patient photography in healthcare operations should be included in the HIPAA-mandated notice of information practices, as well as in the consent for treatment signed on admission. It is advised that a consent paragraph, such as the one below, be inserted into the standard admission consent form.

I understand that photographs, videotapes, digital, or other images may be recorded to document my care, and I consent to this. I understand that [organization name] will retain the ownership rights to these photographs, videotapes, digital, or other images, but that I will be allowed access to view them or obtain copies. I understand that these images will be stored in a secure manner that will protect my privacy and that they will be kept for the time period required by law or outlined in [organization name]’s policy. Images that identify me will be released and/or used outside the institution only upon written authorization from me or my legal representative.

Note: This consent does not authorize the use of the images for other purposes, such as teaching or publicity. A separate consent for photography form should be used for such purposes.

Rohanna

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Re: S/O Gross/unethical pictures
« Reply #22 on: August 21, 2010, 07:46:04 PM »
The paragraphs you link concern photographs that identify patients.

" Images that identify me will be released and/or used outside the institution only upon written authorization from me or my legal representative."

 It does not say anything there about what is going to be done with images that do not identify you. If the doctor wants to take a picture of your enormous kidney stone for his new research paper, well...guess what, he isn't going to ask you.


A lot of stink has been raised because doctors, particularly plastic surgeons and dentists, were using before and after photos of patients (without consent) in their advertising. You can imagine that it would be embarressing to see your face-lift photos on the back of a bus, especially if you hadnt told anyone you had one. That's why employers are so twitchy.

I agree the HC worker in the OP may very well be violating her workplace rules, but HIPPA applies to "identifying patient information"... so it would depend on what the photo was to determine that. Should she be more careful? Yes. Did she violate HIPPA...possibly not. Could she get fired? Maybe. Her bosses may decide to act on a mis-understanding of the law, as in this case

http://www.realtime-itcompliance.com/privacy_and_compliance/2009/08/fired_because_photo_of_surgery.htm

From my readings of it, and my training- if it was a picture of say, like I said, a spleen, or a tumor- and the HC worker works in a large facility...then no, it probably was not a privacy breach. Photos of faces, x-rays, scars, body photos...those are breaches.

Not every photo in a text book needs to have a "model release"... the paragraph above that is quoted again applies to ones that contain PHI, not those that don't.  

I think the HC worker is being careless posting this to FB, and it may very well cost her a job- but I wouldn't say she is being immoral. Just gross.
« Last Edit: August 21, 2010, 07:49:48 PM by Shu »
My friends, love is better than anger. Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we’ll change the world. ~ Jack Layton.

M-theory

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Re: S/O Gross/unethical pictures
« Reply #23 on: August 21, 2010, 07:49:45 PM »
Nope. It refers to all photographs of patients, identifying or not. The consent process for identifying photographs under HIPAA is discussed also - check out AHIMA.

Rohanna

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Re: S/O Gross/unethical pictures
« Reply #24 on: August 21, 2010, 07:57:37 PM »
"2. No “Identifiable” Patient Information in Photo/Recording – Not Required.
For photographs/recordings that do not in any way identify the patient or include any identifying characteristics of
the patient, such as a photograph that excludes (1) the patient’s name, (2) medical record number, (3) patient’s face
or any part of the face that would identify the patient, and (4) all other “identifiers,” a HIPAA Authorization is not
required. In other words, the photograph/recording is completely de-identified, so HIPAA does not apply. See
UAMS De-Identification Policy 3.1.31 to confirm if it is “de-identified” according to HIPAA standards."

(http://hipaa.uams.edu/Photograph%20Release%20Reference%20Tool%2011-3-2004.pdf)

From HIPAA itself

"De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14  De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15"
 (http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html)

My friends, love is better than anger. Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we’ll change the world. ~ Jack Layton.

M-theory

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Re: S/O Gross/unethical pictures
« Reply #25 on: August 21, 2010, 08:02:12 PM »
From HIPAA itself

"De-Identified Health Information. There are no restrictions on the use or disclosure of de-identified health information.14  De-identified health information neither identifies nor provides a reasonable basis to identify an individual. There are two ways to de-identify information; either: (1) a formal determination by a qualified statistician; or (2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15"
 (http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html)



So, do you think she consulted a statistician or talked to the patient before posting the pic to FB?

Rohanna

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Re: S/O Gross/unethical pictures
« Reply #26 on: August 21, 2010, 08:06:58 PM »
It specifically *says* there are two ways to accomplish this. There is a second sentence, and an "or"...

(2) the removal of specified identifiers of the individual and of the individual’s relatives, household members, and employers is required, and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual.15

So if the photograph has no specific identifiers of the patient or anyone related to the patient, and the HC worker isn't say, ignoring the fact that the patient has a large tattoo that everyone in hicksville knows is his, then it's fine to post it.  The second line just says, if there's nothing identifying in the picture, and you aren't ignoring something that you know is identifying, then it's fine.

So you can't post a picture of Bob's spleen if his grandma is in the background- because then everyone will be looking at it going "hey, that's Bob's grandma, and he just had surgery- so that must be Bob's spleen". You also can't post a picture of Bob's unique double-spleen, if you know that everyone in town knows that Bob had a double spleen.

My friends, love is better than anger. Hope is better than fear. Optimism is better than despair. So let us be loving, hopeful and optimistic. And we’ll change the world. ~ Jack Layton.

hellgirl

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Re: S/O Gross/unethical pictures
« Reply #27 on: August 21, 2010, 08:08:59 PM »
Well I'm not familiar with US law, but I did have a grandmother with dementia in a rest home.

If someone took photos of a bedsore (for eg) and put it on fb, even if she wasn't id'able, I would be pretty angry and it would make the papers here. My GM would have been mortified to have her medical issues and person shared with strangers like that, and for their entertainment. It would be taken very seriously as an insult to dignity if nothing else.

Rohanna

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Re: S/O Gross/unethical pictures
« Reply #28 on: August 21, 2010, 08:10:06 PM »
Now note that I have repeatedly said that it may violate her workplace rules- as with my work. I can't take photos of say, a patients elbow, without the patients consent, even though that would most likely be non-identifying, because my work has a "all photos must have consent" rule.
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M-theory

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Re: S/O Gross/unethical pictures
« Reply #29 on: August 21, 2010, 08:14:38 PM »
and is adequate only if the covered entity has no actual knowledge that the remaining information could be used to identify the individual

That's where consent comes in, which is the point I think we're missing each other on.

Regardless of interpretations of HIPAA, what Tammy is doing is certainly unethical, and probably violates her facility's record handling policies as well as (subjectively, it seems) HIPAA. If she thinks this is OK, it's only a matter of time before she does it again with something that's definitely identifiable. It's even remotely possible that the picture has something identifying that isn't obvious to the casual observer. If the picture is from her job and not a medical Web site/random gross picture Web site/her old patho textbook/some other third-party source, she needs to be reported.