Genitals photographed, shared by UPMC hospital employees: a common violation in health care industry

David Wenner
The Patriot News/PennLive.com
Updated September 16, 2017

You might assume anyone in healthcare would know better. Smart phones aren't new. Health care providers have long wrestled with the patient privacy- and medical ethics-related ramifications. Yet once again, smart phones have contributed to a very public black eye for a health care provider.

UPMC Bedford in Everett, Pa. has been cited by the Pennsylvania Department of Health after employees snapped and shared photos and video of an unconscious patient who needed surgery to remove an object from a genital. Numerous employees, including two doctors, were disciplined for being present.

It's not the first time unauthorized photos were taken of a hospital patient and shared or posted on social media.

• Last year, a nurse in New York lost her license after taking a smart phone photo of an unconscious patient's penis and sending it to some of her co-workers. She also pleaded guilty to misdemeanor criminal charges.
• The Los Angeles Times in 2013 wrote about an anesthesiologist in California who put a sticker of a mustache on the face of an unconscious female patient, with a nurse's aid then taking a picture. That article also reported allegations of a medical device salesman taking photos of a naked woman without her knowledge.
• In 2010, employees at a hospital in Florida were disciplined after taking and posting online photos of a shark attack victim who didn't survive. No one was fired, with the hospital concluding the incident was the "result of poor judgement rather than malicious intent," according to an article in Radiology Today. 
• Many such incidents have involved nursing homes. An article published by the American Association of Nurse Assessment Coordination in 2016 stated, "In the shadow of the social media revolution, a disturbing trend has begun to emerge of [nursing home] employees posting and sharing degrading images of their residents on social media." An investigation published by ProPublica in 2015 detailed 47 cases since 2012 of workers at nursing homes and assisted living facilities sharing photos or videos of residents on Facebook. 

The article is here.

What’s the Point of Professional Ethical Codes?

Iain Brassington
BMJ Blogs
June 13, 2017

Here is an excerpt:

They can’t be meant as a particularly useful tool for solving deep moral dilemmas: they’re much too blunt for that, often presuppose too much, and tend to bend to suit the law.  To think that because the relevant professional code enjoins x it follows that x is permissible or right smacks of a simple appeal to authority, and this flies in the face of what it is to be a moral agent in the first place.  But what a professional code of ethics may do is to provide a certain kind of Bolamesque legal defence: if your having done φ attracts a claim that it’s negligent or unreasonable or something like that, being able to point out that your professional body endorses φ-ing will help you out.  But professional ethics, and what counts as professional discipline, stretches way beyond that.  For example, instances of workplace bullying can be matters of great professional and ethical import, but it’s not at all obvious that the law should be involved.

There’s a range of reasons why someone’s behaviour might be of professional ethical concern.  Perhaps the most obvious is a concern for public protection.  If someone has been found to have behaved in a way that endangers third parties, then the profession may well want to intervene.

The blog post is here.

Professional Liability for Forensic Activities: Liability Without a Treatment Relationship

Donna Vanderpool
Innov Clin Neurosci. 2016 Jul-Aug; 13(7-8): 41–44.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers may provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so “clinician” is used to indicate all treatment team members.

Question:

In my mental health practice, I am doing more and more forensic activities, such as IMEs and expert testimony. Since I am not treating the evaluees, there should be no professional liability risk, right?

The answer and column is here.

Professionalism and Conflicting Interests: The American Psychological Association’s Involvement in Torture

By Nikhil A. Patel and G. David Elkin
AMA Journal of Ethics
October 2015, Volume 17, Number 10: 924-930.
doi: 10.1001/journalofethics.2015.17.10.nlit1-1510.

Here is an excerpt:

A violation of medical ethics. “Primum non nocere” (first, do no harm) is a central ethical tenet that applies to all health care professionals, including psychologists. Society trusts us to provide high-quality, ethical care to those who seek our help. While we may not be able to heal all of our patients, this principle of nonmaleficence is a pillar of bioethics that must be considered in deciding whether we are doing “right” by those under our care. As the United Nations (UN) declares: “It is a contravention of medical ethics for health personnel, particularly physicians, to be involved in any professional relationship with prisoners or detainees the purpose of which is not solely to evaluate, protect or improve their physical and mental health”. The fact that the ethics leadership at the APA ensured that the ethical guidelines would be written with the operational interests of the DoD in mind is an affront to the independence and integrity of the profession of psychology.

The guidance that psychologists should defer to legal authority in conflict with professional norms has an alarming similarity to the “Nuremberg defense,” in which doctors on trial after the horrors of the Holocaust argued that they were simply following the orders of their commanding officers and that their actions were legal at the time. An action’s being legal for citizens in general or military officers does not make it ethically acceptable for members of a healing profession.

The article is here.

Doctors Behaving Badly

By Roni Caryn Rabin
The New York Times - Well
Originally published

Here is an excerpt:

Nancy Berlinger, a scholar at The Hastings Center who writes about ethical challenges in health care as well as issues of power between junior and senior clinicians, disagrees. “Doctors must be respectful even if a patient is sedated,” she said. And in these cases, she said, the supervising physicians also did harm to the medical students they were responsible for training and mentoring.

“This is the worst thing a role model can do: to suggest that wrong behavior is acceptable, to nudge junior people to be callous and to misuse power,” Dr. Berlinger said. In both cases, the senior doctors made a trainee student complicit in their abuse and “made them feel dirty at an early stage of their careers.”

The entire article is here.

Some thoughts on the microethics of our professional rules of conduct: Keeping play in imagination

by Anna Guerra, JD, MA, LPC
The Jung Page
Originally published October 19, 2013

A client’s ability to play and imagine is essential to their healing and growth and the provision of a “playspace” where this can happen is a central component of what we do as psychotherapists. Maya Angelou writes, “The needs of a society determines its ethics” (Angelou, 1980, p. 190). “Microethics” focuses on the needs and purposes of our profession, on the ethos underlying our professional rules of conduct, going beyond “the rules,” beyond the “dos and don’ts,” the “shall and shall not” to the “one shall or shall not because we seek to do the following.” Like a microphone, microethics expands and makes audible the reasons for our rules. Providing our clients with a playspace and helping them play is part of what we do as therapists, and it is an ethos written into the various rules of our professional conduct, our ethics.

By play I mean allowing the emergence of imaginal material into conscious awareness. When my clients are “playing” they can allow thoughts, feelings, fantasies, and other material into conscious awareness, into the psychotherapeutic space which if the psychotherapy is working is a playspace.

The entire article is here.

Thanks to Deborah Derrickson Kossmann for this article.

How Should Psychologists Respond to Hateful Comments?

Samuel Knapp, Ed.D., ABPP

Director of Professional Affairs

Conventional words for ethnic groups vary over time, and what is acceptable for a group in one period of time would be viewed as offensive in another time or context. However, at times patients will use words or comments directed at others because of their race, gender, or sexual orientation that clearly offend standards of decency. How should psychologists respond in such situations? Should they ignore the comment or directly confront the patient about the terms that were used?

Discretion is needed to determine when a word is intended as offensive or not. For example, Hawaiians refer to European American residents of Hawaii as haole (pronounced “howlee”). At times it is delivered as a factual statement, “He is a haole” (a white person who lives in Hawaii), and European American residents of Hawaii commonly refer to themselves as haole. However, it could be used as an insult if it were combined with certain adjectives, voice intonations, or hand gestures (Rare storm, 2011).

The conduct of psychologists in addressing hurtful speech, as in other aspects of professional behavior, should be guided by adherence to overarching ethical standards. So, when a patient makes an ethnic slur, the response of the psychologist should be guided by the principles of beneficence (acting to promote the well-being of the patient), nonmaleficence (acting to avoid harming the patient), general beneficence (acting to promote the welfare of the public in general), or other ethical principles.

The context of the comment may be relevant. It is important to know if the comment is related to the patient’s presenting problem, or activated as a function of the perceived characteristics of the therapist (Bartoli & Pyati, 2009). However, I am aware of a few situations where patients have made such intense hate-filled and vitriolic comments (addressed towards groups represented by the psychologist) that a decision was made to refer the patient elsewhere.

In some situations the principle of beneficence (welfare of the patient) may be operative. For example, a young person may use an ethnic term in a manner that an adult considers offensive. Here it is most likely appropriate for correction or feedback because the person might not understand the implications or ways in which the words come across. An educational or non-judgmental exchange could help the young person understand the implications of this speech and how it might impair their social relationships in the future.

The overarching ethical principle of general beneficence holds that psychologists should act to protect the public in general. Consequently, it would seem that, according to this principle, psychologists should address hate-filled comments. However, this ethical principle should be balanced with concerns about beneficence or the welfare of the patient. One patient of mine made a derogatory comment about an ethnic group which I corrected, with as much tact as I could manage. The patient was embarrassed, apologized, and corrected himself. However, if the comment were made in the context of a psychotic episode, disclosure of suicidal intent, or other indication of serious emotional crisis, I probably would have ignored the comment altogether and focused entirely on the patient’s well-being. If the patient had made the comment in response to a particularly upsetting or stressful event, I might have deferred addressing the issue to a time when the patient could get more perspective on the situation.

It is often best to avoid assuming that there will always be a false dichotomy between general beneficence and beneficence. Except in extreme circumstances when patient welfare is at stake or when the hateful comments represent extreme social deviance, psychologists can often find a way to address the issue without harming the therapeutic relationship. Anger and judgmental attitudes should be avoided. Patients are more likely to respond positively to comments made in a calm and direct manner (e.g., “let’s use another word, it makes you come across as prejudiced”).

References

Bartoli, E., & Pyati, A. (2009). Addressing clients’ racism and racial prejudice in individual psychotherapy: Therapeutic considerations. Psychotherapy: Theory, Research, Practice, Training, 46, 145-157.

Rare storm over races ruffles a mixed society. (2011). New York Times. Retrieved from here.