Today’s correspondent has:

… questions regarding social media posting…

I have seen a post … from NSW Ambulance this evening which displays photos of the scene paramedics attended, the suburb of the incident and the medical complaint of the person they attended. While I understand they are telling the public about some of the challenges faced by emergency services, I believe it has the ability to identify the individual.

  • With the big focus on privacy would it be illegal for a paramedic or a government agency to share the level of information that is in the post?
  • Also if the photographer or person posting the image is a paramedic could there be issues with breaching AHPRA code of conduct and/or social media policies?
  • If the post doesn’t currently breach any privacy issues what level of information would be required either through images or captions to breach privacy laws?

I make assumption for the purpose of this question the patient hasn’t granted permission to use the photo and/or the land owner/operator hasn’t granted the permission either.

I have written on the growing tendency of emergency services to release information regarding scenes they are attending.  This is particularly concerning when it comes to ambulance services and paramedics.  See in particular

My correspondent provided the URL to the post where NSW Ambulance says:

Our crews have to attend to patients in pretty difficult environments. Today was another one of those moments. This time in [suburb], Sydney.

Paramedics were responding to a critically ill patient that was in … [a distinctive environment that is photographed]. The [person of an identified gender] had recently suffered a [medical complaint].

Four crews and five flights of stairs later paramedics reached the [person]. [The person] was taken to [a] Hospital in a [described] condition.

Just another day where our paramedics are going to extremes to provide quality patient care.

Now I’ve put it there so you can see the sort of detail that is reported but I’ve tried to remove the identifying material but you can infer that it said the name of the suburb, described by name and photo where the person was found, identified the complaint and the hospital where the person was taken as well as identifying the patient’s gender and condition (stable, critical etc).  Any number of people may have been able to identify the person or, if they knew the person get details of the patient’s condition from that post.

Discussion

In my view that sort of post is not legal. It is a breach of privacy laws.  That patient did not ring or require an ambulance to give the ambulance service a promotional opportunity.  An ambulance was required as the person needed urgent care for a medical condition.  The ambulance service got that information, first by a triple zero call and then by paramedics actually asking the patient questions and observing the patient. It was health information.

Health information is (Health Records and Information Privacy Act 2002 (NSW) s 6):

(a) … information or an opinion about:

(i) the physical or mental health or a disability (at any time) of an individual, or …

(iii) a health service provided, or to be provided, to an individual, or

(b) other personal information collected to provide, or in providing, a health service…

Information about this person’s medical condition is information about the patient’s ‘physical … health’ as is information about his condition – stable, critical etc.  Information about the hospital that they were transported to is information about ‘a health service provided, or to be provided’.  Information about the patient’s gender is ‘other personal information’.  Giving details about where and in what circumstnaces the patient was found means the information is not de-identified

The Health Privacy Principles (set out in Schedule 1 to the Health Records and Information Privacy Act 2002 (NSW)) say that information should only be used for the purpose for which it was collected (Privacy Principle #1 and #10), ie to provide a health service, not to promote the services of the Ambulance service.  Publishing this data is to use this patient as a ‘means to an end’ (ie a way to tell the ambulance service story).

If the person making the post is a paramedic then yes I think there could be disciplinary action.  The Paramedicine Board’s Code Of Conduct: interim (June 2018) says (p. 6) that paramedics:

… must be ethical and trustworthy. Patients or clients trust practitioners because they believe that, in addition to being competent, practitioners will not take advantage of them and will display qualities such as integrity, truthfulness, dependability and compassion

To go and post photos and descriptions of the patient’s condition is, I suggest not being ethical or trustworthy and is taking advantage of the patient for the ambulance service’s benefit.  Further (p. 9):

A good partnership between a practitioner and the person they are caring for requires high standards of personal conduct. This involves:  …

(c) protecting the privacy and right to confidentiality of patients or clients, unless release of information is required by law or by public interest considerations

There is no public interest in disclosing information about a particular patient remembering there is a difference between ‘public interest’ and ‘things that interest the public’.

Applying Baron and Townsend’s ‘Intention-to-Tweet Decision Matrix’ one would have to say this should not be subject to a tweet or any social media publication. The post promotes the service (not the patient’s interests) and tells readers of a specific incident. As Baron and Townsend say ‘This is exploitive: Do not Tweet’ (or I suggest, post to Facebook). Even if it passed that first step it contains ‘Photo(s) from the scene’, the location of the incident, the patient’s gender and the mechanism of illness. On their matrix that would give it 7 points, they say ‘3 or more points = Do not tweet’ (or I suggest, post to Facebook).

Conclusion

The post I’ve been referred to is, in my view, indefensible. I cannot see how the ambulance service could defend its position if there was  a complaint of breach of confidentiality or an action for compensation if it lead to loss (eg if an estranged family member now knew things that the patient did not want them to know).   To turn to the questions:

  • With the big focus on privacy would it be illegal for a paramedic or a government agency to share the level of information that is in the post?

Yes, I think it is a clear breach of the Health Records and Information Privacy Act 2002 (NSW).  I haven’t discussed common law obligations of confidentiality but I think they would be breached too.

  • Also if the photographer or person posting the image is a paramedic could there be issues with breaching AHPRA code of conduct and/or social media policies?

Yes, I think it would be a clear breach of the Paramedicine Board’s Code Of Conduct: interim (June 2018).  Registered paramedics should be resisting their employer’s demand to turn patients into a ‘good news story’.

  • If the post doesn’t currently breach any privacy issues what level of information would be required either through images or captions to breach privacy laws?

That question does not require an answer as I think it does breach current privacy laws.