Physician-rating websites, many of which allow anonymous postings, make it easy for angry patients, unscrupulous competitors and anyone bearing a grudge “to engage in aggressive character assassination,” notes Al Turner, DO, an osteopathic manipulative medicine specialist in Portland, Ore. Although physicians face more hurdles than do many other types of professionals, DOs and MDs can proactively protect and defend their online reputations, say lawyers with knowledge of Internet libel and health care law.
Because of patient privacy provisions in the Health Insurance Portability and Accountability Act (HIPAA) of 1996, as well as state patient-confidentiality laws, physicians generally cannot publicly repudiate false and injurious comments posted by patients on rating sites.
But if those negative comments meet the criteria for defamation—specifically libel, which applies to the written word—DOs and MDs can and should seek legal recourse, says Gary D. Nissenbaum, JD, the managing principal of the Nissenbaum Law Group, which has offices in Union, N.J., New York City, Philadelphia and Dallas.
“The First Amendment gives Americans the right to free expression in a healthy public debate,” Nissenbaum notes. “But there is no First Amendment right to defame someone.” However, because First Amendment protections are so broad, the courts impose rigorous requirements on individuals to prove they have been defamed, he says.
To satisfy the legal definition of defamation, comments need to be false, communicated to a third party and damaging to the injured party’s reputation. But it isn’t always necessary to prove damages. Victims of one category of defamation—known as per se—do not need to demonstrate that they’ve actually been harmed, points out Nissenbaum, whose firm runs an Internet defamation law blog.
Although the law differs from state to state, variations of libel per se include false allegations that someone committed a heinous crime or is infected with a loathsome disease and false attacks on a person’s professional character or status. False attacks generally are the most actionable for physicians, Nissenbaum observes.
Public figures additionally have to prove malice (willfulness or intent) to make a case for libel, including libel per se. “A physician might be considered a public figure in the community depending on the extent to which that physician has injected himself or herself into the public eye,” Nissenbaum says.
Opinion versus defamation
In his third year of a St. Joseph Mercy Health Center residency in dermatology in Royal Oak, Mich., Christopher A. Messana, JD, DO, points out that courts generally do not consider negative opinions to be defamatory. To be labeled libel, false adverse statements must include verifiable factual errors. “If someone says on a rating site that a physician is a jerk, that would be considered opinion,” Dr. Messana says.
The background of the person disparaging another also comes into play when assessing a case for libel, Dr Messana notes. For example, if someone erroneously posts online that a physician “is schizophrenic,” that statement likely would be considered opinion if the poster is a layman rather than a mental health expert or physician. A layman would not be expected to have a medical understanding of the term schizophrenic, he explains.
Dr. Messana asserts that most of the negative comments he has seen on physician rating sites are not worth redressing. Remarks pertaining to physicians’ lack of punctuality, abrupt bedside manner and rude staff should be considered wake-up calls rather than defamation, he says. “We need to do a better job of recognizing that we are in a customer service profession,” Dr. Messana says. “Such comments are reminders that we need to have excellent communication skills and keep wait times reasonable.”
Physicians should also assess the proportion of their negative and positive reviews, advises Jeffrey Segal, MD, JD, the founder and chief executive officer of Medical Justice, a legal advocacy organization that specializes in protecting physicians from Internet defamation and frivolous malpractice suits. “Don’t freak out over a single negative post on a physician rating site,” Dr. Segal cautions. Having only positive comments on a rating site can look suspicious, as if the reviews were planted by the physician, he notes.
It is the more egregious assaults on physicians’ medical knowledge and integrity that should be addressed, according to Dr. Messana. “If someone falsely assails a physician’s clinical acumen or falsely accuses a physician of molestation or another reprehensible crime, that would be defamation,” he says.
“The first step [after getting slammed online] is to evaluate the comments and the amount of publicity they are likely to receive and make a judgment about how harmful they are and what should be done,” suggests Mitchell L. Marinello, JD, a partner with the Chicago law firm Novack and Macy, in a Q-and-A in the March issue of Smart Business Chicago. “Overreacting to negative comments can create more bad publicity or cause a disgruntled critic to become even more vocal.”
The next step, according to Marinello, is to ask the rating site if it will remove the defamatory comments because sometimes such comments violate a site’s policies.
Obtaining legal assistance
Nissenbaum recommends that any victim of online defamation contact an attorney with experience in Internet law. “It is critical for people who believe they have been defamed to seek legal assistance immediately,” he says, noting that defamation has very short statutes of limitation—in many states just one year. “Give the attorney the details: What was said? Where was it said? Why was it said? Was there any truth to it?”
After evaluating the details, the law firm will determine what if anything should be done. “If we conclude that someone has a case for defamation, we address it by being as aggressive as is reasonable under the circumstances,” Nissenbaum says. “A lawsuit is a last resort. But if all else fails, a lawsuit can be filed.”
Considered providers of Internet services rather than content providers, online physician rating services are usually immune from liability for defamatory remarks per the Communications Decency Act of 1996—as long as the sites don’t edit, editorialize about or inject themselves into the user content, Nissenbaum explains.
But the person posting the defamatory content does not have immunity, Nissenbaum continues, noting that the anonymity of most rating-site postings presents a challenge to lawyers. Usually a hearing must take place to determine whether a poster’s anonymity can be overridden. “The First Amendment protects the right of people to engage in anonymous speech on matters of public concern, but the First Amendment principles to protect free speech were not intended to protect defamatory speech,” Nissenbaum reiterates. If a court finds that the poster of libelous statements is not entitled to anonymity, the Internet site may be subpoenaed to disclose the person’s identity.
“You usually can identify the people who write anonymously, and you can pursue them for damages and for punitive damages if their comments are really out of line,” Marinello points out.
To prevent defamatory comments on rating sites, Medical Justice recommends that physicians require patients to sign an agreement. The organization provides its members with template language that can be used in this agreement or integrated into existing patient-intake forms. The current version of the agreement language, according to Dr. Segal, is as follows: “If we do something right, tell us. If we do something wrong, tell us. If you want to say something about us online, think before you push the ‘send’ button. If you post anything defamatory about us, the copyright is ours.”
Having patients sign such agreements makes it easier to force rating sites to take down libelous posts, Dr. Segal says.
Founded in 2002, Medical Justice has worked with physician rating sites to improve their standards, and some of these sites are fairer and more balanced than they used to be, Dr. Segal notes. Thus, the current iteration of the agreement is not as rigid as the original version, which stated that patients waived their right to comment about a physician online.
Endocrinologist Alan B. Schorr, DO, of Langhorne, Pa., says he benefits from belonging to Medical Justice, which provides him with a monthly report of new mentions of his name on rating sites. Because Medical Justice is known for being tough on rating services, merely mentioning the organization’s name can be intimidating, he says. “If I get an erroneous post on a website, I or someone on my staff will call the site and say we’re members of Medical Justice, and the site will respond by taking the post down,” Dr. Schorr says.
Dr. Schorr joined Medical Justice several years ago when a patient threatened him with a groundless lawsuit. “I felt I needed some help,” he says. Since then, he has become vigilant about defending his good name. As Dr. Schorr puts it, “I have a reputation in this part of Pennsylvania that if you come after me with a frivolous claim or a false allegation, I’m going after you.”
In contrast, Seattle family physician Lindy Sue Griffin, DO, takes a laissez-faire approach to the scattered negative reviews she has received on physician rating sites, which she attributes largely to anger over her fees. While mean comments hurt her feelings, she says she understands that some people “feel a need to vent.” Dr. Griffin points out that most of her patients are loyal and praise her in person for the care she provides.
Dr. Messana cautions physicians not to overreact and harm their relationships with patients. To minimize negative ratings, he offers this advice: “Be professional and compassionate, and treat people with respect.”