Featured Guest: Scott Nelson (Host)

A review of actual risk incidents from around the US that made public news

Transcript

Scott Nelson  0:01  
Welcome to The Risky Health Care Business Podcast, where we help you prepare for the future by sharing stories, insights, and skills from expert voices in and around the United States health care world with a mission to inform, educate, and help health care organizations and individuals, ranging from one doctor practices to large integrated systems and organizations throughout the dental, medical, and veterinary health care industry with risk, while hopefully having some fun along the way. I'm your host, Scott Nelson, a guy that grew up in Ohio and has been working all over the United States during my 20 plus year and counting career in the health care industry, with a commitment to accelerating health care performance through creativity, not just productivity. Let's dive in.

Today, we're going to take a closer look at real-life examples that highlight the precarious balance in health care marketing and between areas like promoting health care services and protecting patient privacy. From the pitfalls of social media interactions to the legal quagmires of patient feedback, we’ll explore the complex challenges health care providers, professionals, and patients face in the digital age by asking probing questions that reveal the complex dynamics at play. What transpires when health care marketing goes awry? Why do these incidents happen, and what sparks them? We'll talk about the outcomes, identify the key players, and evaluate the responses—both actual and ideal. By examining the resources utilized and the lessons learned, we aim to shed light on the prudent steps that could have been taken. Whether you're a medical practitioner wrestling with the dos and don'ts of online advertising, a health care marketer striving for ethical engagement, or a patient navigating the sea of online health care information, this episode is crafted to shed light on the risks and responsibilities that come with health care marketing in a hyper-connected world. Join us as we look at several cautionary tales and equip you with the knowledge of the complexities and considerations to navigate and manage potential health care marketing hazards with caution and confidence.

Let’s begin with a story that started with a single social media post. Elite Dental Associates in Dallas, TX, a privately-owned practice, responded to a patient review on Yelp. Instead of a general response, it included the patient’s last name and details about their health condition - a clear violation of the Health Insurance Portability and Accountability Act, better known as HIPAA.

When the Office for Civil Rights at the U.S. Department of Health and Human Services received the complaint, the practice faced a fine of $10,000 and had to adopt a corrective action plan to settle potential violations of the HIPAA Privacy Rule. But the costs went beyond financial - the trust in Elite Dental Associates was shaken, and their reputation tarnished.

Let’s talk about the Elite Dental Associates and OCR case example framework:

What happened? 

Elite Dental Associates in Dallas, a dental practice, settled potential violations of the HIPAA Privacy Rule by agreeing to pay $10,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services. The settlement was in response to a complaint that Elite had disclosed protected health information (PHI) of patients on social media.

Why the incident happened? What was the cause?

The incident occurred because Elite responded to a patient's social media review by revealing the patient's last name and details of their health condition. This disclosure of Protected Health Information or PHI was a breach of the HIPAA Privacy Rule. Additionally, Elite lacked appropriate policies and procedures regarding the disclosure of PHI, particularly in the context of social media interactions.

What was the result? 

As a result, Elite Dental Associates paid $10,000 and agreed to adopt a corrective action plan, which includes two years of monitoring by OCR to ensure compliance with HIPAA Rules.

Who were the people involved?

The people involved were the patient who filed the complaint, the dental practice, Elite Dental Associates in Dallas, and the OCR at the U.S. Department of Health and Human Services.

What was the response? What could or should have been the response? 

Elite's response was to settle the potential violations by paying a fine and agreeing to a corrective action plan. Elite could have already had robust privacy policies in place that complied with HIPAA regulations on public platforms such as social media. 

What were the resources used? 

The resources used were the administrative and legal mechanisms of the OCR and Elite to investigate the complaint, enforce HIPAA regulations, and monitor compliance.

What were the lessons learned? 

The lesson learned is the critical importance of maintaining patient privacy and confidentiality, especially on public platforms like social media. Health care providers must have strict policies regarding the protection of PHI and ensure all staff are trained in these policies.

While Elite Dental Associates' story warns us about privacy breaches, another narrative unfolds in Manhattan, NY where words typed in frustration led to a million-dollar lawsuit. A patient, after feeling misled by billing practices, left a scathing online review of an experience with a gynecologist. The posts, intended to warn others, were met with a defamation lawsuit that quickly escalated into a $20,000 legal battle.

The heart of this issue isn’t just about defamation law; it’s about the very nature of the patient-provider relationship in the era of online reviews. It begs the question: at what point does a patient's right to voice their experience cross into the territory of defamation? And on the flip side, how can health care professionals protect their practices from potentially false and damaging claims?

Let’s talk about the Manhattan gynecologist and patient lawsuit case example framework:

What happened? 

The patient was sued for $1 million by the gynecologist, after posting negative reviews online regarding the experience at the clinic. The patient wrote reviews on sites like Yelp, Zocdoc, and Healthgrades, and also rated the doctor one star on Facebook.

Why the incident happened? What was the cause? 

The incident occurred because the patient was dissatisfied with the services that were received from the gynecologist, particularly objecting to being billed for an ultrasound and a new patient visit which the patient thought should have been part of an annual exam. The patient believed that the business practices were "very poor and crooked," which were expressed in the online reviews.

What was the result? 

As a result of the reviews, the gynecologist initiated a lawsuit against the patient, claiming defamation, libel, and causing emotional distress, demanding around $1 million in damages plus legal fees.

Who were the people involved? 

The people involved in this incident were the patient who wrote the review and the gynecologist who filed the lawsuit.

What was the response? What could or should have been done and by the response? 

The patient's response was to remove all reviews after being sued. However, the gynecologist still pursued the lawsuit for damages and legal fees. The response, as suggested by legal experts and a spokesperson for Yelp, should involve careful wording of online reviews, ensuring factual accuracy, and ideally, resolving disputes directly rather than through litigation.

What were resources used?

The patient reportedly spent close to $20,000 defending against the lawsuit. Legal services and the court system are the resources being utilized in this dispute.

What were the lessons learned? 

The lessons learned are that online reviews should be truthful and based on facts that can be proven, rather than broad generalizations or unfounded claims. This case also highlights the potential legal consequences of posting negative reviews and the importance of free speech balanced with reputational rights.

From the corridors of doctors offices to the bright lights of an operating room, our next case example takes us to Ohio. Dr. Katharine Roxanne Grawe, known as “Dr. Roxy,” took to TikTok to livestream her surgeries. While her intention might have been educational, the State Medical Board of Ohio found her conduct unprofessional. After patients reported complications from her surgeries, the board didn’t hesitate to revoke her medical license permanently and impose a fine.

In the age of social media and celebrity, this case prompts a significant conversation on the lines between patient education, entertainment, and professionalism. How do health care professionals balance transparency and educational content with patient confidentiality and respect?

Let’s talk about the “Dr. Roxy” case example framework:

What happened? 

Dr. Katharine Roxanne Grawe, an Ohio plastic surgeon known as "Dr. Roxy" on social media, had her medical license permanently revoked by the State Medical Board of Ohio. This action was taken after she livestreamed some patient operations on TikTok and three patients reported complications following surgery.

Why the incident happened? What was the cause? 

The incident happened because Dr. Grawe was engaging in practices that the medical board found to be unprofessional and potentially harmful. She was reprimanded for violating patient privacy by sharing photos and videos on social media and was found to have created avoidable complications that required surgical revision. Additionally, she interacted with TikTok users during surgeries.

What was the result? 

As a result, Dr. Grawe’s license was revoked, and she was fined $4,500. She will no longer be able to practice medicine in the state of Ohio.

Who are the people involved? 

Dr. Katharine Roxanne Grawe, the plastic surgeon, was the primary individual involved, along with the patients who experienced complications and the State Medical Board of Ohio.

What was the response? 

The State Medical Board of Ohio’s response was to revoke Dr. Grawe’s license and fine her. Before that, they had summarily suspended her license and sent her multiple reprimands. 

What were resources used?

The resources used were the legal and administrative functions of the State Medical Board of Ohio, which investigated the matter, held hearings, and issued the disciplinary actions.

What were the lessons learned? 

The lessons learned include the importance of maintaining professional standards in medicine, the ethical considerations regarding patient privacy and consent, especially in the age of social media, and the need for a clear boundary between public sharing and patient confidentiality.

What should have been done? 

Dr. Grawe should have upheld patient privacy and consent protocols, refrained from using social media in a manner that could be perceived as unprofessional or detract from patient care, and adhered to the medical board’s standards. The medical board could consider implementing more specific guidelines for medical professionals on the use of social media.

But the story doesn't end here. Across the United States, from New York to Michigan to Ohio, Texas to Scottsdale, AZ health care professionals are engaging in legal battles over social media reviews. Patients who once found solace in the anonymity of the internet are discovering that their words can lead to real-world consequences, including lawsuits and financial ruin.

Let’s talk about the social media negative comments and reviews case example framework:

What happened?

A patient agreed to pay $100 to settle felony charges for sending threatening emails and posting a list on Yelp of surgeries scheduled by his Cleveland Clinic surgeon at the same time as his own surgery, which resulted in complications. The broader issue was the trend of doctors and hospitals suing patients over negative comments and reviews on social media.

Why the incident happened? What was the cause? 

The incident with the patient happened as a result of his ten-year effort against the Cleveland Clinic and his urologist, whom he blamed for the unsuccessful outcomes of his surgery. Other incidents mentioned in the report involve patients expressing their dissatisfaction with medical treatments online, which led to defamation lawsuits by the physicians or hospitals.

What was the result? 

The patient faced up to a year in prison but settled with a $100 payment. Other cases resulted in large legal battles: for example, a doctor sued a former patient over nose job reviews, and a jazz singer criticized for nasal tip surgery faced a $12 million jury award, which was later vacated on appeal.

Who were the people involved? 

The individuals involved included the patient; the Cleveland Clinic urologist; other patients who posted negative reviews; the medical practitioners and hospitals that filed lawsuits; and lawyers and legal experts who commented on the trend.

What was the response? What could or should have been the response? 

The medical community's response in these examples was to sue for defamation in an attempt to protect their reputation. The suggested response for dissatisfied patients is to bring up complaints directly to the medical provider, report to state oversight agencies, or consult an attorney. Experts recommend that doctors should only respond to factually incorrect reviews with the patient’s consent to waive confidentiality.

What were resources used?

Legal resources, such as attorneys and courts, were used to address the disputes. Websites like Yelp also used their terms of service to moderate reviews.

What were the lessons learned? 

The lessons learned include the delicate balance between free speech and defamation, the need for patient confidentiality, and the complexities that arise when medical providers respond to negative online reviews. It's emphasized that consumers should ensure their posts are truthful.

What should have been done?

Patients should address complaints directly with providers before turning to social media. Providers should engage with patients to resolve issues and consider the risks before taking legal action. It's also highlighted that more diligent oversight from regulators could reduce the need for patients to turn to social media for recourse. 

To wrap up today's episode, let's consider the threads that bind these stories together. Each narrative sheds light on the complexity and nuance of health care marketing in a world where online presence is as significant as bedside manner – and both can be a risk and vulnerability to the other party.   We must tread carefully in the digital landscape, uphold the tenets of privacy and professionalism, and always remember the human element at the core of health care. As professionals entrusted with the care of others, we must ask ourselves how our actions, online or offline, contribute to a culture of respect, dignity, and compassion.
Thank you for listening to The Risky Health Care Business Podcast. You can listen to all episodes from the resource center page of the SpringParker website, springparker.com, or click the Listen link in the show notes to listen and subscribe for free on your platform of choice. And remember, accelerating health care performance is achieved through creativity, not just productivity.