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Leaked memo reveals the US' largest health system could fire nurses who post coronavirus policies on social media — and a nurse has already been suspended without pay

HCA healthcare
HCA Healthcare, the country's largest health system, in an email barred employees from posting publicly about its policies for treating coronavirus patients. Rusty Russell/Getty Images

  • HCA Healthcare, the largest hospital system in the country, sent an internal email on March 24 about its employee social-media policy during the coronavirus outbreak.
  • The email, reviewed by Business Insider, revealed that the company could fire employees who spoke with news outlets or posted on social media about the health system's coronavirus policy.
  • One nurse told Business Insider that one of HCA's hospitals had suspended her without pay for violating this policy in a post in a private Facebook group. In a statement to Business Insider, the hospital said she is under investigation for posts that disclosed patient health information.
  • Visit Business Insider's homepage for more stories.
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The largest healthcare system in the US has told employees that it could fire nurses and doctors who speak publicly about its policies regarding the novel coronavirus outbreak, according to an internal memo reviewed by Business Insider.

HCA Healthcare, which has 185 hospitals in 20 states, sent an email to employees on March 24 that added new guidelines for social media and media inquiries during the pandemic. The email said HCA employees could get disciplined or even fired for posting information on social media about its policies about treating patients with COVID-19, the illness caused by this coronavirus. The health system also barred employees from speaking to journalists about the virus without explicit permission from HCA's communications director.

One nurse, Jhonna Porter, told Business Insider that HCA Healthcare had already suspended her for violating these new guidelines and did so retroactively, for her activity before March 24. Porter, a charge nurse at West Hills Hospital in California, said HCA Healthcare suspended her without pay on March 25, a day after sending the email updating its social-media policy.

West Hills Hospital provided a statement to Business Insider, confirming that it had suspended Porter and saying that it is investigating posts of hers that may have disclosed patient health information. HCA Healthcare referred to the West Hills Hospital statement.

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Porter told Business Insider that she hadn't violated the new policy and that she believed the actual reason for the suspension was that she has been a whistleblower, calling out hospital equipment shortages. And now her freedom of expression is being stifled during a crisis, she added.

Her case paints a picture of how hospitals have been pushed to the brink by the coronavirus pandemic, and how the strain is starting to show.

Hospitals might be cracking down on nurses who call out dire mask shortages during the coronavirus pandemic

Experts have predicted that the novel coronavirus outbreak, which as of Monday had infected more than 336,000 Americans, will push US hospitals and health systems to their limits. Hospitals have a limited number of intensive-care-unit beds and ventilators, or machines used to treat respiratory illnesses such as COVID-19, creating chaos for nurses and doctors treating the rapidly increasing number of patients.

Many healthcare workers have used social media or spoken with news organizations, including Business Insider, to call out the shortage of protective equipment like masks and the lack of protocol for treating COVID-19 patients. Nurses and other healthcare workers are worried that inadequate supplies will leave them at risk of contracting the disease

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Business Insider's Lydia Ramsey reported last month that experts from HCA Healthcare helped devise coronavirus response plans for use at hospitals nationwide.

Porter said HCA Healthcare issued her suspension over a phone call and told her it was for talking to her colleagues in a private Facebook group about a floor the hospital had turned into one for treating patients with COVID-19. Porter said the health system said her social-media activity was a violation of the federal Health Insurance Portability and Accountability Act, commonly known as HIPAA, which mandates that healthcare workers keep patient information private.

West Hills Hospital, owned by HCA Healthcare, told Business Insider the social media policy hasn't changed since May 2019, but administrators updated it to "encourage increased vigilance with regard to patient privacy" during the coronavirus pandemic. 

Porter said her post did not name the health system or mention sensitive patient information. Rather, she said, she was being punished for being a whistleblower who called out equipment shortages and other hospital issues.

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"I know my HIPAA laws, and I didn't violate HIPAA," Porter said in an interview with Business Insider, adding that she told a hospital representative that she "felt singled out" and "felt attacked."

"I said many nurses are all posting the same things that I am — why am I the only one being suspended?" she said. "He had no answers for me."

Porter said her union representative had asked HCA about the specific reason she was suspended and had not received an answer other than that she had been put under "investigatory suspension." West Hills confirmed that Porter is under investigation for posts that may have disclosed patient health information.

HCA Healthcare is publicly traded, with backing from the private-equity firms Bain and KKR, which took the system private in a $33 billion deal in 2006, at the time the largest leveraged buyout in history. Its market capitalization on Monday was nearly $30 billion.

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Read the email HCA Healthcare sent to employees on March 24:

As employees we all are a reflection of the brand and thus are at the very core of the fabric that keeps the organization intact.

It is of the upmost importance that we follow the social media/media inquiry guidelines — these are meant to protect our employees, patients and the organization.

During this time of heightened media attention around COVID-19 some of you may be contacted by a variety of media sources via social media, email, text, or phone call.

Social Media/Media Inquiry Guidelines:

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    • Personal social media accounts are a reflection of your personal brand and the company, so if you choose to interact with the brand in either a positive or a negative manner this is public and can be monitored
    • Unless specifically authorized, employees are restricted from speaking on behalf of the HCA Healthcare
    • Employees are expected to protect the privacy of patients, employees and other stakeholders and are prohibited from disclosing patient information without proper authorization
    • Employees are also prohibited from disclosing proprietary or confidential information to which they have access and work with as part of their job duties, without proper authorization, inclusive of recent policy changes due to COVID-19
    • Do NOT provide information on patient statuses/information — IT IS A HIPAA VIOLATION and will be treated as such
    • All media inquiries should be fielded by the Director of Strategic Communications ONLY 
    • Directors of Strategic Communications are highly trained professionals in media relations, brand/reputation management, crisis communication and have HCA specific compliance training around their roles
    • Non-compliance around these policies can result in disciplinary actions up to and including termination.

Attached are the HCA approved social media guidelines that should be adhered to at all times.

Our goal is to ensure that information around COVID-19 is accurate and in line with the CDC guidelines. All HCA generated social media activity is compliant with these guidelines and reflective of the truth.

Note: The text has been updated throughout to reflect that HCA Healthcare has only said that it could fire nurses who violate its social-media policy, and to include comment from West Hills Hospital, owned by HCA. 

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