The ‘Selfie Challenge’ and Misuse of Patient Images

The news story from Okaloosa County, Florida, about the criminal investigation alleging that two paramedics were taking “selfies” with patients in various states of consciousness as part of a “selfie challenge” was shocking. How could EMS professionals do such a thing?

Granted, these allegations — like posing with an elderly patient with her breasts exposed, or with an unconscious patient while holding his eyelid open — are among the most graphic and disturbing we have heard. But we are seeing an increase in serious cases involving public safety personnel improperly taking and then misusing patient images. Federal and state laws protect the privacy of patient information — including images — and in many of these cases, the HIPAA privacy regulations are violated. And, as in this case, there can be criminal sanctions against those who violate the patient’s trust in a way that blatantly violates the patient’s dignity as a human being.

The law is clear: HIPAA only permits the use and disclosure of protected health information without authorization in cases where there is a legitimate health care purpose, such as sharing information among health care providers treating the patient, for payment purposes (billing) and for quality improvement.

Taking images of patients for self-gratification, as part of a personal “contest,” or some other type of sick humor is certainly not permissible under HIPAA. Even if the patient consents to the image (as was alleged with some of the photos in this case) that consent should be in writing and must specifically describe the purpose for which the image will be used. There can also be charges of assault, battery or other crimes for the non-consensual touching of the patient while taking these grotesque images.  

But the root cause of these violations of the patient’s trust go much deeper. In my view, they are in great part caused by a lack of respect for the patient and a failure to treat others with dignity. This often comes from a bad attitude, or allowing the many difficult – or themselves abusive — patients we encounter to drive our behavior in negative ways. That behavior can then, unfortunately, be reflected in improper, unprofessional and even illegal behavior toward others — and especially the patient.  We simply cannot let the negative aspects of the job affect how we treat our patients.

Jim Page said it very well many years ago in a keynote speech he gave at the annual paramedic luncheon at Acadian Ambulance Service in Lafayette, Louisiana: “A wise person once said that a society can best be judged by how it treats the old, infirm, and powerless.”

An EMS agency is judged by how it treats patients and the public that it serves. EMS agencies that actively and consistently emphasize in their mission the importance of respect, courtesy and dignity in all interactions generally have fewer complaints from patients and the public and the least likelihood of an incident like the “selfie challenge.”  

We have great power over others in our role as EMS providers. It can be all too easy to take advantage of that power and misuse it. The solution to avoiding situations like the “selfie challenge” is to always treat others with respect and dignity — and that includes not just the patients, but their families, our co-workers, other public safety providers and the public at large.

Here are five tips for avoiding the risk of improperly using patient images:

1. Establish a Culture of Respect and Dignity
Do EMS agencies need to remind everyone how important it is to be kind, respectful and courteous to others? Absolutely. Communicating expectations from the top down in any organization is key to developing and maintaining a positive culture that prevents inappropriate behavior. Comprehensive policies should clearly prohibit the improper use of personal devices like smartphones and set proper parameters for their use.

2. Conduct Sensitivity Training on How to Deal with Those with Special Needs
As Jim Page said, “Sensitivity — unlike riding a bicycle — can be forgotten if not practiced.” Initial and regular training on the unique needs of the diverse community we serve — and then actively practicing those skills, can reduce the likelihood of taking improper advantage of others. That was the basis of the allegations in this “selfie challenge” case.

3. Actively Practice Empathy
Always put yourself in the patient’s shoes and try to understand the situation from their perspective.  Appreciating the patient’s viewpoint leads to active listening, better communications, improved sensitivity and a better understanding of the patient’s emotional and medical needs.  The result is better treatment for the patient.

4. Practice Management by Being There
It is a well-known adage that when someone is watching, compliance with guidelines radically improves. The leadership team needs to be active, visible and monitor what is happening on the street. Far worse than a front-line EMS provider with a poor attitude is the supervisor with a poor attitude, who looks the other way when observing behavior that is contrary to the values of the organization.  It would seem incredible that in a case like this “selfie challenge” that others in the organization, especially supervisors, would not know about it. Leadership needs to be in touch with what is happening on the street.

5. Have Pride in What You Do and Show it!
EMS is noble work. We have tremendous positive impact on the lives of others — even if that is just gently holding the hand of an elderly patient and talking to them with kindness. Not every call gives us the opportunity to save a life. But every call does give us the opportunity to affect someone’s life. We can better serve the patient’s needs when we have healthy pride in what we do — it greatly reduces the risk of taking advantage of others who are vulnerable and less fortunate.

After all, as Jim Page said so eloquently, “Isn’t this what we all want America to be like? People who are good at what they do, people who are proud of what they do, and people who treat their customers with respect and dignity.”

The bottom line: Treat others the way you want to be treated, and the way you want your family members treated. When EMS providers respect the tremendous power that they have over the health and well-being of others, they are more likely to respect the patient and provide service in a competent, professional and compassionate way. The ancillary benefit is that this approach can do wonders to avoid the negative headlines that can severely damage the reputation of individual EMS providers and their EMS agency.

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