Inappropriate Facebook postings by family and friends of the patient

[morman]

A young parent of young children recently coded in our emergency room. Unhappily, resuscitation was unsuccessful. Once the body was cleaned up, family and friends were allowed in to say their goodbyes. Someone posted pictures of the deceased on Facebook which were widely circulated and commented upon, not always favourably.

This patient was well known by us as a very private and dignified individual. In your facility, how do you help to protect a person's dignity when they can no longer give consent? When do you consider your duty to care to be ended in a case like this?

[Penelope_Pitstop, BSN, RN]

We view it as a potential hippaa violation of any patient

How, though?

The family isn't caring for the patient.

I'm not trying to be difficult, I'm just wondering. I've never worked ED, so my experience is completely different. We did have a videotaping policy but essentially it stated that any staff member had to consent to being videotaped, nothing about the patients themselves.

[morman]

No, I have NEVER stalked anyone on social media. The idea of that or of posting anything less innocuous than funny pet videos is absurd.

And yes, it would be so easy to say "not my problem". Too easy. It's ironic that, in my first post, I was accused (unjustly) of being unethical and here, most responders are basically advising me to pass the buck or ignore my instincts. I respectfully disagree that our duty of care is discharged when the patient dies. That includes the decedents continued right to privacy and dignity...

[MunoRN, RN]

Were they drawing genitalia on their face with sharpies then taking pictures of them? That would clearly violate the patient's dignity, but just taking a picture is actually a normal thing for a lot of people, so I'm not sure why it is you're so sure that they are violating the patient's dignity.

[NurseGirl525, ASN, RN]

But how do you know the patient never said to his family, I don't care if you take pics of me. I know it sounds absurd, but you don't know. Taking pictures in death is common. And it's not your issue. They are the family. They are allowed to do what they want.

You and your colleagues are the ones that are not allowed to post pics on Facebook. Hipaa applies to health care workers not the family.

This is an adult patient, not a child which was kind of insinuated from your post. And you may think it is awful, but it is how this family is grieving. If another family member has a problem, then they take it up with each other. These days everything gets posted on Facebook, including death and it's how our society deals with things. We don't always agree with what everybody else does, but there is nothing illegal here.

[NursehoneyBeBe]

Taking picture is not allowed in my facility. There's a whole policy on it. We let the family members know that it is against hospital policy. But if they take it when no one is there we really can't control what they do because we can't confiscate their phones or anything. People post anything on fb and social media these days it's disgusting. Why they would even want to post a pic of the deceased is beyond me.

[brattygrl]

A young parent of young children recently coded in our emergency room. Unhappily, resuscitation was unsuccessful. Once the body was cleaned up, family and friends were allowed in to say their goodbyes. Someone posted pictures of the deceased on Facebook which were widely circulated and commented upon, not always favourably.

This patient was well known by us as a very private and dignified individual. In your facility, how do you help to protect a person's dignity when they can no longer give consent? When do you consider your duty to care to be ended in a case like this?

Late to the conversation.

Anyhow, our hospital policy is to not leave the deceased alone until they are taken to morgue. We take turns as nurses sitting in with the deceased and family members mourning.

We make sure the body is not manipulated prior to autopsy (its peds, so most get autopsies).

We also make sure our no photos policy is followed at that time. Can be very stressful as staff at times, thats why we relieve each other.

[hppygr8ful, ASN, RN, EMT-I]

No, it was an adult who has young children. And no, I doubt anyone sought the family's permission to post the picture.

I guess my question is that, if we wouldn't allow media to take such pictures for reasons of patient confidentiality, why would we not extend that ban to members of the general public as well? It would be completely unenforceable though...

Just my take on this as I haven't read the full text of HIPAA in a while but if Hospital staff knew the photography session was taking place they had a duty to stop it. Although deceased the patient is still under HIPAA protection as long as the remains are in the care/custody of the hospital. I polite "I'm sorry but we do not allow pictures to be taken in ER." would have been appropriate. We had a patient family member the other night walking the halls making a Youtube video about our facility the other night and I had to tell them that filming in the facility was not permitted due to privacy issues. Of course they got mad but later my DON stated I did the right thing.

Hppy

[realnursealso/LPN, LPN]

I want to know how you know this was done? Family can do as they please. You seem to be well versed about this. Who saw the picture on Facebook? As PP's have said, it is quite common for some families to take pictures of their deceased relatives. What they do as a family is up to them.

[NurseStorm, BSN, RN]

You will be in more trouble for looking at this person's social media than the person posting it.

I would use the "not my problem" card here.

Some people live in small communities/areas with small populations and due to mutual friend circles you may see things at times related to a patient due to comments a mutual friend makes, if one of your friend shares something, ETC. I live in a small area and I have quite a few times seen things due to friends liking, commenting or sharing things on a person I had as a patient. Sometimes I am already friends with someone on facebook because we went to high school together for example, and then they later become my patient. Small town issues that seem like what the OP was talking about. I doubt she searched up the patient somehow. Seems like a widely shared thing in their area perhaps.

[NurseStorm, BSN, RN]

How, though?

The family isn't caring for the patient.

I'm not trying to be difficult, I'm just wondering. I've never worked ED, so my experience is completely different. We did have a videotaping policy but essentially it stated that any staff member had to consent to being videotaped, nothing about the patients themselves.

I don't know that it's HIPAA violation per se (I'm Canadian..) but I think what they are implying is that by one family member taking pictures there is the possibility they may violate the privacy of other patients through inadvertently having either the patient themselves, charting with names, board with pt name, etc, in the background. This would be definitely inappropriate and break the assumption of privacy and confidentiality one should have in the ER. Whether that is exactly breaking HIPAA I'm not sure (also not sure if I have the right letters ) but it's definitely a potential breach in privacy and confidentiality.

[calivianya, BSN, RN]

No, I have NEVER stalked anyone on social media. The idea of that or of posting anything less innocuous than funny pet videos is absurd.

And yes, it would be so easy to say "not my problem". Too easy. It's ironic that, in my first post, I was accused (unjustly) of being unethical and here, most responders are basically advising me to pass the buck or ignore my instincts. I respectfully disagree that our duty of care is discharged when the patient dies. That includes the decedents continued right to privacy and dignity...

Your instincts are good here, it's just that you don't have any LEGAL right/obligation to do anything about it, and may actually run into legal hot water if you do.

Is it tacky and inappropriate of people to take pictures of dead people in the hospital? I certainly think so. However, the extent of what we can do is tell people photography isn't allowed in the hospital. We certainly can't confiscate visitors' personal belongings. We can't forcibly take things out of their hands and delete their pictures.

The dead people aren't going to sue the hospital because their privacy got violated; but the visitors just well might if they feel like they were "assaulted" by a camera being taken out of their hands.

There are a lot of moral things that you will run into that are not legally enforceable, and you just have to deal with it. This is one of them.