Tri-City doctor's Web site contains X-rays
By: PAUL SISSON - Staff Writer | ∞
OCEANSIDE -- Though Tri-City Medical Center recently fired nine employees for photographing and disseminating patient X-rays, a doctor at the hospital maintains a personal Web site that contains similar anonymous patient records.
The Web site -- erpocketbooks.com -- is published by Dr. David Pregerson and contains 20 "cases of the month" where emergency room cases are discussed in detail and, in some cases, are accompanied by digital images of X-rays.
While the case of the month files appear to be geared toward the medical community, a different link leads to material of general interest. For instance, the Web site sells pocket books, including one entitled "Don't try this at home" that includes 147 examples of emergency room injuries and instructs visitors to "read and learn from the mistakes of others (with a laugh here and there)."
Reached by phone Wednesday, Pregerson declined to discuss his Web site or how he obtained the photographs of medical records posted there. The doctor said he preferred to speak to the director of the emergency department before giving an interview.
"I am very interested in education and prevention," Pregerson said last week. He did not return subsequent calls seeking comment.
Tri-City announced May 11 that it would fire 10 workers -- five nurses, three technicians and two secretaries -- for photographing, printing and viewing a patient's X-ray in violation of hospital privacy policies. A nurses' union official announced Friday that one of the five nurses had been rehired after a termination hearing exonerated her.
Dr. Ken Iwaoka, the hospital's medical chief of staff, said recently that an investigation into the actions of two doctors who were also involved in the matter showed that neither did anything wrong.
Iwaoka declined to say whether Pregerson was one of the doctors involved in the incident.
Tri-City officials also would not comment on whether the photographs posted on Pregerson's Web site came from Tri-City's emergency department or whether the doctor obtained patients' consent before publishing the information.
When asked what method Pregerson used to obtain the photographs on his Web site, chief of staff Iwaoka said in an e-mail: "The medical staff is looking at all complaints of privacy issues related to members of the medical staff."
Tri-City administrators say they are firing nine employees for violating hospital confidentiality and privacy policies which prohibit taking photographs without permission and also for failing to report photographs taken by others to hospital bosses.
Asked whether Pregerson's Web site might also violate hospital policy, hospital executive Suellyn Ellerbe said in an e-mail that doctor discipline is the domain of Tri-City's Medical Executive Committee, a governing body made up of doctors.
"Regarding this incident, medical leadership has reviewed activities of members of the medical staff. Actions taken by the (Medical Executive Committee) are confidential," Ellerbe said.
While photographing the X-ray that led to Tri-City's recent batch of firings may be against hospital policy, it does not appear to violate federal privacy laws.
Ellerbe said that the hospital's computer system automatically removes all identifying information from X-rays before displaying them on screen. Likewise, when X-rays are printed, Ellerbe said, no identifying information is attached to the image.
Bill Hall, a spokesman for the U.S. Department of Health and Human Services, said Friday that taking a photograph of an X-ray that has had all of its identifying information scrubbed away does not violate the Health Insurance Portability and Accountability (HIPAA) Act of 1996. That law, which took effect in 2003, holds all health care agencies responsible for keeping patients' medical records private.
What's more, Hall said there is no reason why such an image, devoid of name, Social Security number or other identifying mark, cannot be published.
"If a piece of a patient's health information is completely de-identified, no consent from that patient is required for use of the information," Hall said.
While patient consent may not be required, Dr. Michael Kalichman, director of the Research Ethics Program at UCSD, said Friday that getting permission before publication is still the most ethical choice.
Kalichman said that an X-ray, especially one which shows an "obvious identifier" like a tumor in a patient's left lung, could still be used to make an identification.
He said doctors are better off erring on the side of caution unless they have permission.
"Given the risk of error, and given public and private sensitivities about medical information, it seems reasonable to expect that any use of such data will be carefully considered and done only with explicitly permission from those involved," Kalichman said. "In the rare cases where this is not necessary, a reasonable burden to be placed on the user of the information is to include an explicit statement of why that permission is not needed."
-- Contact staff writer Paul Sisson at (760) 901-4087 or psisson@nctimes.com.
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To Paul Sisson wrote on May 22, 2007 3:07 AM:Now you're cooking. Keep up the investigative reporting efforts. You will never get any comments from hopsital spokespersons. We on the streets know there plenty more.
Nurses Weeks wrote on May 22, 2007 3:14 AM:Came and went without any fireworks or Thanks to the Nurses... Tri City brought upon themselves a lot of bad press. Nurses do so much THANK YOU, for bringing to light the inconsistencies between insider contract doctors, inside medical employees... Keep up the good work! and please continue to keep mentoring the newbie nurses. We don't want them influenced by the moola... we want them to be influenced by the love of the profession because they care to deliver quality patient service.
Board Meeting 5/24 and 5/31 wrote on May 22, 2007 3:19 AM:Please attend both board meetings before you go out of town for the Memorial Holiday. On the 24th meeting begins at 6:00pm to discuss hiring a successful bond consult. On the 31st meeting begins at 3:30pm to discuss many important issues, Nurses contract, Gonzalez Pay Raise (used to step all of his VPs, managers, and directors), and many many more items. Be there or Be square - your tax dollars are at work.
Money Motivator or Education wrote on May 22, 2007 3:23 AM:Did Doctor Pregerson get the blessings of his ER group's associates? Is any of the revenue generated from the sales being given back to the hospital - CEO, or ER doctors group? Did he file appropriate paperwork with the IRS, or State, for a business license, fictitious name, and use of public property? The website shows Tri City's identfiers, and Oceanside Police cars. Who approved this from the hospital board or were they again the last to know?
Vox Populi wrote on May 22, 2007 7:19 AM:This was never about the privacy of patients but a management-union controversy that has long been festering at Tri-City. CEO Gonzales, who makes well over $500k/year to head a public, non-profit hospital that belongs to the taxpayers, has long run this facility like a for-profit hospital. This story points out the dichotomy where doctors can put sensitive patient material on their website and union employers have a hard time getting due process under the law. It all boils down to plain old union busting.
Sisson is a hack writer wrote on May 22, 2007 7:50 AM:You call this a story.Give me a break!There is a big difference between doctors using pictures of x-rays for educational purposes and doing so according to professional standards and nurses and techs taking pictures of x-rays and psychiatric patients with camera phones.To "Nurses Weeks", apparently you aren't a nurse at Tri-City.Tri-City had an entire week of events thanking nurses for their work. It's pretty clear that the same person wrote all the first four posts on this blog.Unless you would have us believe that there are four completely different people up at 3 in the morning bloggin on this topic.Come on!
Nanchi wrote on May 22, 2007 7:59 AM:Although HIPPA rules may not have been broken, would most patients be happy that secretaries and even doctors are using x-rays to get a laugh?
TCMC ED RN wrote on May 22, 2007 9:50 AM:Wow, I can't believe that is a story. Dr. Pregerson is a well respected, intelligent Emergency room physician. He is an educator. His web site is very usefull and does not violate anyones privacy. I'm sorry for you if you disagree. Whoever dug this up, has got to GET A LIFE. IT's not a witch hunt.....Tricity Medical center is going to lose a lot of skilled, caring employees.Nanchi...you have to realize....people do some pretty strange things to thier bodies...it is interesting to the medical community how these issues are solved...example..foreign bodies in certain cavities.....etc...the medical community is interested or we would not be in the field. It's not about a laugh, it's still educational no matter how shocking.
Is this allowed? wrote on May 22, 2007 10:09 AM:It seems to me that the hospital should have a rule about removing medical records from the premises. If one is at a teaching hospital, then there should be written procedures to determine if such publication of materials is authorized, desirable, or tolerated. I go to Green Hospital and they do have forms that one signs to allow for 'educational' purposes. That's fine so long as one knows ahead of time. Yes, education is a good thing but let's put some policies in place- I don't feel that the doctor here is very ethical and an ethics policy is required prior to anything like this happening. Good article!
TCMC ER RN wrote on May 22, 2007 11:57 AM:I found xrays on the mayoclinic web site. OH My, should we be shocked? take a look. I found someones coronary arteries from angiography and their ekg. Should we find out if they got permission?
To Vox Populi wrote on May 22, 2007 1:30 PM:Tri City SHOULD be run like a for profit hospital. The same kind of accountability that applies to a for profit business should apply to my tax dollar. That is why the educational system in California is in trouble, simple failure to operate it like a business. Holding people accountable for their preformance, hitting bugetary guidelines, paying reasonable, but not exorbinate wages make for a well run facility. Not for Profit should never mean less accounability! You don't see private business throwing money around like the school districts and non profits.
TCMC ED RN wrote on May 22, 2007 2:51 PM:I doubt that the secretaries were copying x-rays of anything educational. It is disturbing to me as a sometimes patient that this is going on in the workplace.
Joe B wrote on May 22, 2007 3:09 PM:What the real question is: did this doctor give money to the bond measure or for board members? If the answer is yes, then nothing will happen to him.
Joe B wrote on May 22, 2007 3:11 PM:GOD!!! My files are exploding with fodder to take the hospital on again. :-) Thanks Tri-City, and Alan, keep up the great marketing. You are right, the Public Affairs Director you hired is great... for me and all opposition. I wonder what the movers and shakers think.
Joe B To the Hack wrote on May 22, 2007 3:15 PM:Paul is actually a good journalist, he may not always have tact, but he is a lot better to the hospital than he should be. If you want to see a hack, look at the writer for the Union-Tribune, that's a hack. He let's great stories go, and slants them heavily toward Tri-City.
Interesting website wrote on May 22, 2007 3:20 PM:I visited the website referenced in the article - I highly recommend that everyone check it out themselves and draw your own conclusion. Personally, I found nothing that would even remotely raise privacy concerns - this website is geared toward the healthcare professional, and its purpose is to avoid mistakes in making emergency diagnoses. There is also a resource section for the lay public on "how to avoid finding yourself in the ER" - we all could benefit from this material (especially me, who spent a recent Sunday there after attempting to severe my finger). Bottom line: Nice try, but this really isn't the big scoop the article implies.
doctors above the law wrote on May 22, 2007 4:48 PM:Just because an x-ray does not have "identifying" information on it does not make it a doctor's or hospital's property to use for any purpose -- the patient owns the x-ray and must give consent to any use of that x-ray not directly related to his medical treatment. In teaching hospitals patients are asked to sign away this privacy right. I would urge all patients treated at Tri-City to review this website and if they recognize their x-ray they should pursue the hospital for privacy violations. This is an egregious breach of the physician's duty to do no harm to his patient and a breach of the patient's privacy rights, and conversion of the patient's property - the x-ray - for profit.
To doctors above the law wrote on May 22, 2007 6:30 PM:While I agree with your first sentence, I completely disagree with the rest of what you wrote. You don't know whether or not the physician got permission to use patient info. You don't even know if the info used is from TCMC patients. Don't you think you should know the facts before you urge people to do anything?
reply to doctors wrote on May 22, 2007 8:22 PM:That is why I suggested people review the website to see if their x-rays or CT scans are there --because I don't know if they gave permission. And, it doesn't matter if they were treated at TCMC or not, if those x-rays, MRIs, or CT scans were used without permission from whatever facility they were taken at, it still is a violation of privacy. Maybe the doctor should put a disclaimer on his website that all such images are published with the consent of the patient. I seriously doubt that is the case.
To doctors above the law wrote on May 22, 2007 8:41 PM:Of the many medical educational sites on the web, please show me just one that has a disclaimer on the site stating that xray images are plublished with the consent of the patient. Thanks.
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