A 5-year-old boy, patient B, was brought to the emergency department (ED) by his parents. His symptoms included headache, sore throat, vomiting, fatigue, and abdominal pain. He was examined and diagnosed with streptococcal pharyngitis, prescribed an antibiotic, and discharged from the ED within an hour of arrival (6:00 PM).

After the family returned home, patient B’s condition worsened; he was vomiting and couldn’t keep down the medicine. By 2:00 AM, patient B’s mother was concerned enough to take him to another hospital ED.

At the ED, patient B was not triaged as urgent, despite his mother’s telling the staff that the boy had a sudden onset of symptoms including headache, nausea, vomiting, lethargy, weakness, dizziness, balance issues, slurred speech, and photophobia. She also told the staff that he had been to another hospital earlier that day.

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Two hours after arrival in the ED, patient B was seen by Ms C, a nurse practitioner. In her notes, Ms C charted that patient B “presents with sore throat for unknown time … was seen at other hospital this evening 6 PM. DX [diagnosed] strep. PT sent home and then mom states he has been vomiting every hour and not able to keep meds down. The onset was unknown. The course/ duration is constant.” Ms C did not check with the other hospital, perform a neurologic examination, or order any imaging. She did, however, admit the child.

At approximately 5:00 AM, patient B was seen by 2 family practice residents, neither of whom performed a neurologic assessment or ordered a computed tomography (CT) scan of the child’s head. Although one resident mentioned that a neurologic examination should be done, the exam was deferred as the child was sleeping. At 10:00 AM, about 8 hours after he had arrived at the hospital, the child suffered a stroke.

A code blue was called, and subsequent examination showed a mass on the brain. The stroke left the child paralyzed, with neurologic damage and other permanent injuries.

Patient B’s parents hired a plaintiff’s attorney and sued everyone involved — the first hospital, the second hospital, and the treating nurse practitioner and physicians.

In the complaint against Ms C, the plaintiffs alleged that patient B “suffered a catastrophic and medically-preventable stroke that left him with right-side paralysis, neurologic damage, and other debilitating physical injuries that permanently changed his and his parents’ lives.”

They alleged that although Ms C admitted patient B for observation, she “failed to chart that he suffered from debilitating headache, inability to walk, severe lethargy, weakness, dizziness, slurred speech, photophobia, inability to answer basic questions, and severe imbalance.” They also alleged that the symptoms were a clear indication that a neurologic assessment and CT scan of the head were needed, and that Ms C was negligent.

In their suit, the plaintiffs claimed that the defendants were both negligent and committed misconduct and requested that they be allowed to seek punitive damages as well as compensatory ones. Claiming punitive damages meant that Ms C’s reckless and careless attitude, not simply a lapse in judgment, was a factor in the child’s outcome. As part of their complaint, the plaintiffs included social media postings by Ms C. The online postings consisted of cartoons, jokes, and dark satire that referenced topics such as job frustrations, job duties (including patient charting), interactions with patients, disdain for children, and drinking.

The plaintiffs contended that Ms C’s posts were “a direct reflection of her unprofessional attitude, complete lack of training and qualifications, and her inability to be a patient advocate” and that Ms C’s “attitude toward her profession, her job, her patients, and children are a display of and explanation for her wanton and willful failures” toward the child.

Through her defense attorney, Ms C made a motion to strike the social media posts, claiming they were primarily designed to scandalize her, harm her general reputation, and spectacularize the case to the public.

Legal Background

The task here “is to parse what sections are pertinent or material to the claims in the case and what sections are simply scandalous,” wrote the court in its decision. The court noted that the plaintiffs are “not permitted to include unnecessary, scandalous, and unduly prejudicial information” in a complaint. Ultimately, the court decided that some of the social media posts were acceptable for use in the complaint and some were not.

The court accepted the social media posts that it considered material or pertinent to the complaint, including memes about refusal or inability to fill out medical charts and memes about patient complaints. The court rejected social media posts it believed were included only to embarrass Ms C, such as posts about job dissatisfaction, memes about children, and posts about drinking. The case is proceeding with some of the social media posts included in the complaint, although the judge noted that the trial judge will decide specifically what the jury will be allowed to see.

Protecting Yourself

Do not kid yourself into believing that your social media profiles are private or limited. When you post something on a public platform, even if you weren’t intending for the entire public to see it, it is still in the public domain. The plaintiffs in this case, while seeking punitive as well as compensatory damages, are clearly planning to use the social media posts as evidence of what they believe to be Ms C’s reckless and careless disregard for patients.

It would be wise to think twice before posting anything related to your work, your patients, or your workplace on an online platform.