The Role of Investigative Journalism in Uncovering Healthcare Issues

On Mar 27, 2024

In general, investigative journalism plays a crucial role in society by exposing corruption, malpractice, and wrongdoing that influential institutions often seek to conceal. With respect to healthcare, the impact of investigative reporting has been profound, detecting scandals that have protected public health, patient safety, and brought much-needed transparency to the industry.

The International Consortium of Investigative Journalists (ICIJ) has played a pivotal role in uncovering critical healthcare issues through its groundbreaking investigations. One such investigation is the Implant Files, a collaboration with 260 journalists from 36 countries, which exposed the flaws and lack of safety testing in the $400 billion global medical device industry.[1]

The investigation was spearheaded by Dutch journalist Jet Schouten, whose initial reporting on faulty vaginal mesh implants in the Netherlands sparked the broader investigation. Through rigorous data analysis and collaboration, the Implant Files team uncovered patterns of device malfunctions, injuries, and inadequate regulatory oversight across the globe. Despite the impact of the Implant Files, Schouten highlights the ongoing challenges in reporting on the medical device industry, particularly in Europe, where access to information and regulatory transparency remain significant obstacles. However, she emphasizes the importance of tenacity, collaboration, and following one’s passion to drive meaningful change and hold institutions accountable for patient safety and public trust.

From uncovering unethical pharmaceutical marketing practices that fueled the opioid crisis to exposing substandard care in nursing homes during the COVID-19 pandemic, investigative journalists have consistently held healthcare systems accountable. Their work has prompted policy changes, legal actions, and a broader public reckoning on critical healthcare issues.

The Importance of Investigative Journalism in Ensuring Equitable Healthcare Access

At its core, investigative journalism aims to reveal stories and information that would otherwise remain hidden from public view. As the Dutch-Flemish Association of Investigative Reporters (VVOJ) notes, it involves “creating new facts” and “interpreting or connecting already known information in a new way.”[2]

In healthcare, this watchdog role is vital for uncovering issues that institutions have an incentive to conceal – from medical malpractice and corruption to corporate misconduct and policy failures. Investigative reporters doggedly pursue leads, cultivate sources, and analyze data to bring these stories to light, often facing significant legal and personal risks.

Investigative Techniques and Methodologies

Successful healthcare investigations employ a range of techniques to obtain and verify information. This includes:

Obtaining and analyzing data, records, and documents through freedom of information requests, leaks, and public databases.
Conducting interviews with sources, subject matter experts, and those impacted by the issues under investigation.
Using undercover tactics and covert reporting methods when necessary to gain access to restricted information or environments.
Collaborating with advocacy groups, researchers, and other journalists to pool resources and expertise.

As Salud con lupa director Fabiola Torres highlighted at the Global Investigative Journalism Conference, creating databases from public information requests is essential for tracing issues like pesticide use across borders.[3]

Understanding the Implications of HIPAA Violation

HIPAA violation cases occur when an investigation by the Department of Health and Human Services (HHS) Office for Civil Rights (OCR) identifies serious violations of the HIPAA rules worthy of financial penalties. Common violations include impermissible uses and disclosures of protected health information (PHI), failure to provide individuals access to their medical records, lack of appropriate safeguards and risk analyses, and workforce training failures.

OCR has significantly increased its enforcement activities in recent years, imposing more financial penalties for non-compliance. In 2020 alone, 19 HIPAA violation cases were settled, many related to OCR’s HIPAA Right of Access enforcement initiative cracking down on entities that fail to provide timely access to medical records.[4]

The consequences of HIPAA violations can be severe, with fines determined by the level of negligence and the number of records exposed if a breach occurred. Penalties range from $137 to $2,067,813 per violation category per year, depending on factors like wilful neglect. In 2019, OCR issued guidance capping maximum annual penalties at $25,000 for low-level violations, $100,000 for reasonable cause, and $250,000 for wilful neglect, until further rulemaking makes this permanent.

Notable Healthcare Exposés

Some of the most impactful healthcare exposés in recent history include:

Case 1- The U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) settled with Yakima Valley Memorial Hospital for $240,000 after investigating an incident where 23 security guards impermissibly accessed 419 patients’ medical records. HIPAA protects health information privacy and security. To resolve violations, Yakima Valley Memorial Hospital agreed to update policies/procedures, train workforce on preventing snooping, conduct a risk analysis, develop a risk management plan, review business associate agreements, and be monitored by OCR for 2 years. OCR Director Melanie Fontes Rainer stated health organizations must have robust policies preventing unauthorized workforce access to patient information.[5]

Case 2- Green Ridge Behavioral Health, a provider of psychiatric services in Gaithersburg, MD, experienced a ransomware attack that exposed the protected health information (PHI) of 14,000 individuals. The Office for Civil Rights (OCR) investigated and found multiple potential violations of the HIPAA Privacy and Security Rules by Green Ridge. Specifically, they failed to conduct an accurate risk analysis, did not reduce risks to electronic PHI (ePHI), lacked policies and procedures for reviewing system activity records, and impermissibly disclosed the PHI of over 14,000 patients. Green Ridge settled with OCR, made no admission of wrongdoing, and paid a $40,000 penalty.[6]

Case 3- In 1932, the U.S. Public Health Service began the “Tuskegee Study of Untreated Syphilis in the Negro Male” involving 600 Black men, 399 with syphilis. Participants did not give informed consent and were misled about the study’s purpose. Despite penicillin becoming the syphilis treatment by 1943, participants were denied treatment. The unethical study continued until 1972 after media exposure. A lawsuit resulted in a $10 million settlement in 1974. In 1997, President Clinton issued a formal apology. The study highlighted the need for policies protecting human subjects in medical research, leading to regulations like the Belmont Report and Common Rule.[7]

Case 4- St. Joseph’s Medical Center in New York allowed an Associated Press reporter access to three patients’ clinical information during COVID-19 without obtaining authorizations, violating HIPAA Privacy Rules. The Office for Civil Rights investigated after seeing a media article with patient details. Although the medical center responded to a public health emergency, the impermissible disclosures resulted in an $80,000 settlement with OCR.[8]

As these examples illustrate, investigative journalism has repeatedly played a pivotal role in uncovering critical healthcare issues that authorities and corporations aimed to suppress.

Challenges Associated With Investigative Journalism

Despite their contributions, investigative journalists face numerous obstacles in their pursuit of healthcare stories. Legal hurdles, such as HIPAA privacy regulations and defamation laws, can impede access to information and sources.

Moreover, the decline of press freedom in some regions, as evidenced by the media landscape in Hungary under Orbán’s leadership, poses a severe threat to independent journalism. Strategic Lawsuits Against Public Participation (SLAPPs) are increasingly used to intimidate and silence journalists through costly legal battles.[9]

Closing Thoughts

Investigative journalism has played an indispensable role in uncovering some of the most pressing healthcare issues of our time. From exposing the opioid epidemic and patient safety concerns to cracking down on healthcare fraud and abuse, these journalists have served as a powerful force for accountability and reform.

Through dedicated support, innovative collaborations, and an unwavering commitment to truth, investigative journalists will continue to uncover the stories that powerful institutions seek to conceal – stories that have the potential to save lives and drive positive change in healthcare.

As the healthcare industry continues to evolve and new challenges emerge, investigative journalism remains a vital safeguard against malpractices, corruption, and systemic failures that jeopardize the well-being of patients and the integrity of our healthcare systems. It is a call to action for continued vigilance and unwavering commitment to uncovering the truth, no matter how deep it is concealed.

[1] https://www.icij.org/inside-icij/2023/12/how-reporting-on-the-medical-device-industry-has-changed-five-years-after-implant-files/

[2] https://gijn.org/fr/member/dutch-flemish-association-for-investigation-vvoj/

[3] https://gijn.org/stories/best-practices-for-investigating-healthcare-issues/

[4] https://www.hipaajournal.com/hipaa-violation-cases/

[5] https://www.hhs.gov/about/news/2023/06/15/snooping-medical-records-by-hospital-security-guards-leads-240-000-hipaa-settlement.html

[6] https://www.hipaajournal.com/green-ridge-behavioral-health-hipaa-penalty/

[7] https://www.cdc.gov/tuskegee/timeline.htm

[8] https://healthitsecurity.com/news/hhs-settles-hipaa-investigation-with-st-josephs-over-phi-disclosure-to-media

[9] https://www.hrw.org/news/2024/02/13/hungary-media-curbs-harm-rule-law

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