Legal Strategy Checklist for Doctors to Fight Online Defamation

With the increase in popularity of online review sites, defamatory attacks against doctors have also increased. On these sites, patients and competitors can post almost anything they want – good or bad – about a doctor or any health care professional. As more physicians become employees of hospital systems or large health care institutions, adverse surveys, reports or reviews may impact advancement, bonuses and basic income.

Internet ratings on review sites like Vitals.com and Yelp.com can range from jabs about the patient’s waiting time in the doctor’s office to ruthless attacks that can seriously impact a physician’s career, including economical impact. In many cases, the review, comment, or rating may be a purposely untrue statement by a disgruntled patient, competitor or former employee. When the comment is posted, search engines like Google, Yahoo, Bing, AOL, or MSN may bring up the false statement every time someone searches for that doctor’s name. This can cost doctors both their reputation and their business, especially if they start losing patients because of bad reviews.

Many doctors are now seeking legal strategies to combat alleged online libel and defamation in order to save their reputation and their practice. However, not all negative online comments or ratings meet the actual definition of “defamation.” Defamation generally is a factual statement that can be proven true or false. For example, if a patient writes that she had a procedure performed by a doctor, this is a statement of fact that can be confirmed or disproved. However, if someone writes about a doctor’s poor attitude during a visit, this statement is usually considered to be an opinion which cannot necessarily be proven true or false.

If you find any statements about you or your practice that may be considered defamatory, the following are some legal measures you may take to try to stop the inflammatory comments:

1.  Identify person making comments.
Attempt to identify the person making the negative remarks. You may find it is a disgruntled former employee or a friend or relative of the patient who does not have any first-hand knowledge. See other tips below on how you might do this. Contact that person directly.

2.  Check your office records.
Your own records should be checked. Your notes about office visits or procedures, your appointment schedule or your own billing records may help you identify the patient who wrote the review or comment. If you think you may know who wrote a comment, try to contact the patient directly to discuss his or her concerns and request that the comment be removed. Sometimes you will find that you never treated this patient or that the patient has the wrong physician.

3.  Consult with an attorney.
Before making any decisions about the contents of a comment, consult with an experienced attorney for guidance. An experienced attorney will be able to determine whether the internet posting is considered an opinion or defamation.

4.  Send a letter to the website, host, owner and internet service provider.
Once the poster has been identified, doctors can contact the patient directly to ask that the post be removed. If the patient refuses, a doctor should request that his or her attorney send a letter warning the poster of potential legal action if the post is not removed from the website. If that doesn’t work, the physician should have his or her attorney send a letter demanding the comments be removed to the website, website host, owner and internet service provider.

5.  Contact the website.
If you are unable to determine who may have written something online, or if the person refuses to take the comment down, try contacting the website that the review or comment is posted on. Many websites have policies against defamatory statements. Contact the website to ask about its policy and get the comment removed. However, be very careful about signing up as a participant on the website and, especially, of agreeing to its terms of service (TOS) or terms of use (TOU). See below.

6.  Avoid agreeing to the website’s terms.
Avoid the urge to join the website, subscribe to the website or otherwise agree to the website’s policies and procedures. You may be agreeing to a legally enforceable contract that waives your rights to sue for defamation or other course of action. Every website has Terms of Service (TOS) or Terms of Use (TOU), usually with a simple block to check to acknowledge you agree to all of its terms. Do not do this. You may be waiving all of your rights to legally challenge defamatory comments that are published.

7.  File a lawsuit.
Filing a lawsuit should be a physician’s last resort in handling defamatory online comments. Legal proceedings can often take years to complete and can draw more negative attention to the physician. However, in many cases the only way for a physician to defend his or her reputation is in court.

Before you can file a lawsuit you must check state laws regarding statute of limitations in which to file defamation suits. If the negative comment falls outside this statute of limitations, you will not be able to sue. You will also need to review state defamation and false light laws to see what are considered appropriate claims. Remember it is difficult to sue someone for an opinion, and many online reviews can be considered and can’t be proven true or false. It is also usually best to sue the individual poster, not the website, as The Communications Decency Act of 1996 protects Internet service providers from liability for third-party comments.

8.  Seek a subpoena.
If the website provides no assistance in removing the comment, you and your attorney can seek a subpoena ordering the Internet service provider to give identification data. Generally courts will grant a subpoena during a defamation investigation. Identification information could be an email address, name or location information of the poster. 

9.  Request a court order.
If all requests for a post to be removed are unsuccessful, doctors can request a court order or an injunction. A doctor must be able to show that the comments are probably false and are causing irreparable harm to their reputation or practice in order for a judge to demand the comments be removed. Usually you will be required to file a petition or complaint (lawsuit) first.
There are also alternative methods for protecting your reputation online. Be proactive and make sure you are putting out positive information about yourself and your practice through your website, social media sites, and blogs. This will help bury negative comments that appear on search-engine results, making it less likely that potential patients will see bad reviews.

Physicians should also distribute surveys to their patients, which provide an instant forum for patients to express their feelings about visits. Such tools as having your own internal office complaint/grievance procedure for patient complaints may help. If patients feel that they are able to provide immediate feedback to a physician, they may be less inclined to share their feelings online.

For more information, please visit our website at www.TheHealthLawFirm.com.

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4 responses to “Legal Strategy Checklist for Doctors to Fight Online Defamation

  1. Content Scraper

    MINNEAPOLIS — A man’s online post calling a doctor “a real tool” is protected speech, the Minnesota Supreme Court ruled Wednesday. The state’s highest court dismissed a case by Duluth neurologist David McKee, who took offense when a patient’s son posted critical remarks about him on rate-your-doctor websites. Those remarks included a claim that a nurse called the doctor “a real tool,” slang for stupid or foolish.

    The lawsuit followed the hospitalization of Laurion’s father, Kenneth, for a hemorrhagic stroke at St. Luke’s Hospital in Duluth. Laurion, his mother and his wife were also in the room when McKee examined the father and made the statements that Laurion interpreted as rude.

    Laurion expressed his dismay in several online posts with what he considered the doctor’s insensitive manner.

    Laurion had posted his comments on a website where patients review their doctors. The case has been watched with interest because of the potential conflict between free speech versus protection of professional reputations on the Internet.

    On at least two sites, Laurion wrote that McKee said that “44 percent of hemorrhagic strokes die within 30 days. I guess this is the better option,” and that “It doesn’t matter that the patient’s gown did not cover his backside.”

    Laurion also wrote: “When I mentioned Dr. McKee’s name to a friend who is a nurse, she said, ‘Dr. McKee is a real tool!'”

    He expected at most what he calls a “non-apology apology.”

    “I really thought I’d receive something within a few days along the lines of ‘I’m sorry you thought I was rude, that was not my intent’ and that would be the end of it,” the 66-year-old Duluth retiree said. “I certainly did not expect to be sued.”

    He was. Dr. David McKee’s defamation lawsuit was the beginning of a four-year legal battle that ended Wednesday when the Minnesota Supreme Court ruled the doctor had no legal claim against Laurion because there was no proof that his comments were false or were capable of harming the doctor’s reputation.

    In 2011, State District Judge Eric Hylden ruled that McKee was not defamed by the criticism and dismissed the doctor’s lawsuit.

    McKee appealed to the Minnesota Court of Appeals; and in January 2012, that court sent the case back to the district court for a jury to decide whether six statements Laurion posted about McKee on rate-your-doctor websites and distributed elsewhere were defamatory.

    Laurion appealed the Court of Appeals decision to the Supreme Court and the case was heard in St. Paul in September.

    Writing the opinion, Justice Alan Page noted that McKee acknowledged that the gist of some of the statements were true, even if they were misinterpreted.

    The ruling also said it doesn’t matter whether the unnamed nurse actually exists. McKee’s attorney argued that Laurion might have fabricated the nurse, something Laurion’s attorney denied. And it said the doctor’s objections to Laurion’s other comments also failed the required legal tests.

    “Referring to someone as ‘a real tool’ falls into the category of pure opinion because the term ‘real tool’ cannot be reasonably interpreted as stating a fact and it cannot be proven true or false,” Page wrote.

    For full articles:

    http://bigstory.ap.org/article/minn-high-court-say-online-post-legally-protected
    Minnesota high court says online post legally protected

    http://www.duluthnewstribune.com/event/article/id/257287/
    Court protects Duluth doctor’s online critic

    http://www.startribune.com/local/189028521.html
    Duluth doctor’s lawsuit against patient’s son over online criticism dismissed

    http://comments.startribune.com/comments.php?d=content_comments&asset_id=189028521&s ection=/local&comments=true
    Star Tribune comments

    http://learningboosters.blogspot.com/search/label/.%20McKee%20v%20Laurion
    Laurion answers questions

    http://blogs.duanemorris.com/duanemorrisnewmedialawblog/entry/bedside_manners_was_the_d octor
    Was the doctor defamed?

    http://www.mncourts.gov/opinions/sc/current/OPA111154-0130.pdf.
    Unanimous ruling of the Supreme Court of Minnesota

  2. This entire experience has been distressing to my family. We were initially shocked and blindsided by “jocular” comments made so soon after my father’s stroke by somebody who didn’t know us. We were overwhelmed by my being sued after posting a consumer opinion, and we were shocked by the rapidity with which it happened. It has been the 800 pound gorilla in the room. My parents would be 88-year-old witnesses. My mother and wife prefer no discussion, because they don’t want to think about it. Conversation with my father only reminds him of his anger over this situation. My siblings and children don’t often bring it up, because they don’t know how to say anything helpful. I have been demoralized by three years of being called “Defendant Laurion” in public documents. While being sued for defamation, I have been called a passive aggressive, an oddball, a liar, a coward, a bully, a malicious person, and a zealot family member. I’ve been said to have run a cottage industry vendetta, posting 108 adverse Internet postings in person or through proxies. That’s not correct. In reality, I posted ratings at three consumer rating sites, deleted them, and never rewrote them again.

    The plaintiff’s first contact with me was a letter that said in part that he had the means and motivation to pursue me. The financial impact of being sued three years to date has been burdensome, a game of financial attrition that I haven’t wanted to play. The suit cost me the equivalent of two year’s net income – the same as 48 of my car payments plus 48 of my house payments. My family members had to dip into retirement funds to help me.

    After receipt of a threat letter, I deleted my rate-your-doctor site postings and sent confirmation emails to opposing counsel. Since May of 2010, postings on the Internet by others include newspaper accounts of the lawsuit; readers’ remarks about the newspaper accounts; and blog opinion pieces written by doctors, lawyers, public relations professionals, patient advocates, and information technology experts. Dozens of websites by doctors, lawyers, patient advocates, medical students, law schools, consumer advocates, and free speech monitors posted opinions that a doctor or plumber shouldn’t sue the family of a customer for a bad rating. These authors never said they saw my deleted ratings – only the news coverage. Newspaper stories have caused people to call or write me to relate their own medical experiences. I’ve referred them to my lawyers. I’ve also received encouragement from other persons who have been sued over accusations of libel or slander.

    It was not my intention to use any descriptions or conclusions. It was also not my intention to claim that I had proof. Only my family and the doctor were in the room. My intention was to portray my recollection of what happened in my father’s room. The public could decide what to believe and what – if any – impact it had on them: insensitive doctor or overly-sensitive consumer?

    Medical peer newsletters or magazines that interviewed the plaintiff did not approach me. Websites maintained by doctors for doctors or lawyers for lawyers often caused an inference that I was a zealot family member or somebody who had asked about my dad’s chances and then shot the messenger. Generally, however, those websites echoed other websites in advising public relations responses other than a lawsuit – for fear of creating the “Streisand Effect.” As a retired layman, I brought far less resources to the battle of financial attrition.

    I’ve learned that laws about slander and libel do not conform to one’s expectations. I’ve read that online complaints are safe “if you stick to the facts.” That’s exactly the wrong advice. I did not want to merely post my conclusions. I wanted to stick to my recollection of what I’d heard. I don’t like to read generalities like “I’m upset. He did not treat my father well. He was insensitive. He didn’t spend enough time in my opinion.” However, such generalities are excused as opinion, hyperbole, or angry utterances. If one purports to say what happened, factual recitations can be litigated. The plaintiff must prove the facts are willfully misstated, but the defendant can go broke while waiting through the effort.

    I feel that defamation lawsuits are much too easy for wealthy plaintiffs. If I were to attempt suing a doctor for malpractice, my case would not proceed until I’d obtained an affidavit from another doctor, declaring that the defendant’s actions did not conform to established procedures. In a defamation suit, there’s generally no exit short of a judge’s dismissal order – which can be appealed by the plaintiff. Being called “defendant” is terribly personal, but the civil suit path is totally impersonal. During the three years that I went through depositions, interrogatories, a dismissal hearing, an appellate hearing, and a state Supreme Court hearing; I never once spoke to a judge. At depositions, the plaintiff and I sat opposite each other, while I answered his lawyer’s questions, and he answered my lawyer ‘s questions. We were not to speak to each other.

    Minnesota and two other states allow “hip pocket” lawsuits. The plaintiff can start a suit by sending the summons and complaint to the defendant without filing the documents in court. The plaintiff enjoys complete anonymity from public awareness. The defendant has 20 days to respond, but the court is unaware that the suit exists. The plaintiff can conduct interrogatories and depositions while the court is unaware that the suit exists. The plaintiff can send settlement demands to the defendant ‘s insurance company while the court is unaware that the suit exists. Until the suit is actually filed, the plaintiff’s lawyer orchestrates everything as the officer of the court. If the defendant files his answer, in order to publicly get onto the docket and under the supervision of a judge, the defendant pays the filing fee. In Minnesota, if the plaintiff loses his effort at rule by law, the rule of law generally allows the defendant no remuneration. The plaintiff can lose the suit while winning the battle of financial attrition.

  3. These physician rating sites should NOT allow anonymous postings. Anonymous postings leave the door open for defamatory statements, fake postings by a physician’s competitor, a former disgruntled employee, or other abuses. I know of at least one case where untrue statements were posted by a physician’s former partner who wanted to ruin his business. If a person cannot stand behind their comment, then the comment is likely to be inappropriate or untrue. Also, if someone has a complaint, they should try to reach out to the source first. Communication is always a good thing….and that goes both ways. If providers won’t properly communicate with patients and their families, they are asking for trouble. Sometimes a patient or a family member is grieving or in distress and they just need someone to listen to them and show they care. On the other hand, I know of one case where a physician went above and beyond (spending over an hour) talking to a family member about their elderly father who refused to have a Biopsy and treatment for a serious Cancer. The standard of care is to get a Biopsy for a definitive diagnosis before starting Cancer treatment. However, this patient refused and did not keep their follow-up appointment for treatment. Then approximately 6-8 months later defamatory comments made by an anonymous poster showed up on at least 4 or 5 physician rating websites falsely accusing this doctor of not telling the patient he had Cancer which was clearly not true ! This unfairly affected the physician’s reputation who had an otherwise excellent record of caring for Cancer patients over many years. Falsely accusing a physician of misdiagnosing a patient and not telling the patient they had Cancer when he clearly had diagnosed and informed the patient properly is nothing short of viscous defamation !

    • Well said Joan. It is unfortunate that defamatory and untrue statements are made against health care professionals and providers online. Our best advice it to be proactive and make sure you are monitoring what is posted about yourself and your practice through different websites, social media sites, and blogs.

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