Offensive online behaviour has offline consequences

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A doctor has been suspended for six weeks after making a number of offensive social media posts, including encouraging the assault of women

The high-profile case provides a timely reminder for all health professionals, including pharmacists, to understand their obligations when posting on social media, says PSA national president Dr Chris Freeman.

Dr Christopher Kwan Chen Lee appeared before the Health Practitioners Tribunal in Hobart on 16 April regarding social media posts he had made between 9 December 2016 and 10 December 2016 which identified him as a medical practitioner.

The Tribunal heard a number of comments posted on the Singapore-based forum in 2016.

These included:

  • “This kind will NEVER learn. She needs to be abandoned in India and repeatedly raped in order for her to wake up her idea.”
  • “I can just as easily condemn your mother for a whore (if the situation warranted it) as I can save your life or even hers.”
  • “If I don’t’ like you, there won’t be any kid gloves. Some women deserve to be raped, and that supercilious little bitch fits the bill in every way.”
  • “With her suicide, nothing of value would be lost.”

On the online profile Wikidot, Dr Lee described himself (on or before 9 January 2018) as a “mongrel doctor who claims to know all manner of shit on earth”.

“It is rumoured that his hospital in Australia has the highest casualties in the world due to him not attending to his dying patients,” this profile read in part. It also referred to his wife: “There’s some tiagong that he was forced into the marriage because his wife had threatened to report him to police for raping her, after he spiked her curry then upped her after their graduation prom night.”

On or before 16 January 2018 he also wrote on the Hardware Zone forum that “If my marriage fell apart, it would not end in divorce. It would end in murder,” the Tribunal heard.

On 3 December 2017, after Dr Lee received notice that he was subject to a notification under the National Law, he posted again on the forum, regarding an article describing the jailing of an Egyptian lawyer who had said women who wear ripped jeans should be raped as punishment.

“I’m surprised they didn’t give him a medal instead,” Dr Lee wrote.

The posts were not made in the course of practising medicine and were posted after Dr Lee’s working hours. However, several photographs he posted of himself on the forum clearly identified him by name and as a medical practitioner.

Dr Lee had been employed by the Tasmania Health Service between February 2016 and February 2018. At the time of the hearing he was based in Box Hill, Victoria, and had begun a role as emergency registrar at Box Hill Hospital in 2019.

Dr Lee said that at the time he posted the comments, “he was relatively young and inexperienced and he had a brash and opinionated bent to his conduct on social media”. He is currently 31 years old.

The Tribunal noted that he did not fully appreciate that posting comments on a Singapore-based forum would have consequences for his practising medicine in Australia.

“The joint submission stressed that despite the respondent’s above mentioned online conduct he has not permitted his socio-political and other personal views to colour or influence his medical practise and he has certainly never been discriminatory or derogatory towards the groups of individuals that his comments are alleged to be inflammatory of.

“He says it can be demonstrated that no violations surrounding direct patient care can be attributed to the respondent through his entire medical career, and a recent clinical supervisor can confirm the respondent has constantly conducted himself in a professional and compassionate manner while in the workplace.”

An experience emergency physician submitted a reference in which Dr Lee was described as “warm, engaging and affable and has excellent communication skills”.

The Tribunal heard that Dr Lee had been issued a caution on 23 July 2018, in relation to accessing a Royal Hobart Hospital patient’s health records on 21 occasions between July 2015 and December 2016. This access had been inappropriate as it was done without consent or clinical need.

Chairperson Robert Webster said the risk of harm to the public was “material and significant”.

“The nature of the posts was forceful and they were strongly conveyed. They carried a higher risk of inciting inappropriate social behaviour that could jeopardise the public,” he observed.

“A person reading the posts and in particular a woman or a person of a particular race who might present to Dr Lee could be fearful they would not be treated professionally and appropriately.

“At worst there is a risk Dr Lee might not be treating persons appropriately or respectfully or alternatively patients might leave a facility where Dr Lee is practising because they are fearful of how they might be treated.”

He said that it appeared both the conduct on social media, and the accessing the record which had been the subject of the previous caution, “can be characterised as conduct which overstepped professional boundaries which the respondent was unaware of”.

He noted that Dr Lee’s response to his questions showed he did not fully know the extent of his obligations under the Code and the social media policy, but now does; he also noted that doctors are required to know what these obligations are when practising the profession of medicine.

Chairperson Webster found that Dr Lee’s conduct amounted to professional misconduct.

He ordered that Dr Lee be reprimanded and his registration be suspended for a period of six weeks, beginning 16 April 2019.

Conditions were imposed on his registration requiring him to undertake education on ethical behaviour and communications, particularly in the use of social media.

On April 22 2019, Dr Lee again posted on the Hardware Zone forums.

“We’ll see who has the last laugh,” he wrote, adding a winking emoticon.

The Guardian now alleges that he has also shared images of patients, including X-rays, which did not reveal the identity of patients.

Dr Alison Dwyer, Chief Medical Officer, Eastern Health – of which Box Hill Hospital is a part – issued a statement saying that Eastern Health complies with all findings of the Medical Board of Australia and will comply with the findings of the tribunal regarding Dr Christopher Kwan Chen Lee.

“We have initiated a review into the implications of the tribunal findings for Dr Lee and Eastern Health. Dr Lee will not be returning to work until completion of this investigation,” she said.

“At Eastern Health we value diversity, inclusivity and living together respectfully and do not tolerate disrespectful comments or racism in any form.”

Dr Chris Freeman, national president of the PSA, encouraged pharmacists to ensure they understand what they should and should not post online.

“It’s a timely reminder for pharmacists to familiarise themselves with their Code of Ethics and the Professional Practice Standards, and understand how those also relate to the use of social media,” he told the AJP.

He pointed out that both the PSA, in its Code of Ethics, and the Pharmacy Board issue guidance on social media use.

In the Code, “there are a variety of different principles which speak to how pharmacists should conduct themselves ethically and professionally. Within that, it does speak to behaviour related to social media.

“For example, under one of the integrity principles it suggests that a pharmacist should act with honesty and integrity and maintain public trust and confidence in the profession. The detail in that principle also applies to social media and digital health.

“Pharmacists have an obligation under the Code and should refrain from taking part in activities that would diminish that in any way.”

He also cautioned pharmacists from making remarks online which could defame individuals or organsations.

He added that posts made on social media are there “forever”.

A spokesperson for AHPRA and the National Boards told the AJP that the National Boards’ social media policy makes very clear that a registered practitioner should act in the same way online as they do in person.

“Whether an online activity is able to be viewed by the public or is limited to a specific group of people, health professionals need to maintain professional standards and be aware of the implications of their actions, as in all professional circumstances,” the spokesperson said.

“Health professionals need to be aware that information circulated on social media may end up in the public domain, and remain there, irrespective of the intent at the time of posting.”

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