August 3, 2016
VIA ELECTRONIC TRANSMISSION
Jocelyn Samuels
Director
Office for Civil Rights
Department of Health and Human Services
200 Independence Avenue, SW
Washington, DC 20201

Dear Director Samuels:
On February 9, 2016, I contacted HHS regarding the troubling problem of nursing home
abuse via social media. This previous correspondence noted dozens of instances of elder abuse
beginning in 2012 and perpetrated through the use of social media platforms such as Facebook,
Instagram, and Snapchat. For example, my letter noted the case of an Illinois man, Channing J.
Butler, who was accused of soliciting men to have sex with elderly women in a memory care
facility where he was an employee. 1 Following his arrest, Butler was charged with solicitation to
commit aggravated criminal sexual assault. 2 This instance was just one example of a troubling
practice of elder abuse within nursing homes that often consists of nonconsensual photographs of
partially nude residents shared on Snapchat, Facebook, and Instagram. 3 These cases demonstrate
the ease with which the elderly can be abused and exploited using emerging social media websites
and technologies.
While the individuals in the previous cases faced action from their employers and
prosecution by state authorities, a recent instance of abuse has escaped prosecution as a result of
authorities deeming that the activities did not violate the law. In March of this year, in Hubbard,
Iowa, a certified nursing assistant shared a photo of a nursing home resident with dementia with

1
Mary Schenk, Man arrested over alleged plot to videorecord sex with memory-care patients, THE NEWS
GAZETTE (Jan. 19, 2016), http://www.news-gazette.com/news/local/2016-01-19/man-arrested-over-alleged-plotvideorecord-sex-memory-care-patients.html
2
Id.
3
See Charles Ornstein, Inappropriate Social Media Posts by Nursing Home Workers, Detailed, ProPublica (Dec.
21, 2015), https://www.propublica.org/article/inappropriate-social-media-posts-by-nursing-home-workers-detailed.

 Director Jocelyn Samuels
August 3, 2016
Page 2 of 3

his pants around his ankles, and his legs and hand covered in feces. 4 The nurse assistant sent the
photo to friends, captioned “s--- galore,” utilizing Snapchat.5 However, despite the clearly
abusive and exploitive nature of this activity, Iowa’s dependent abuse law deals only with “sexual
exploitation of a dependent adult by a caretaker,” which state health officials deemed to be
inapplicable in this situation because the dependent’s genitals were not shown. 6
While Iowa lawmakers are confronting this gap between the law and modern technology,
it is important to understand the standards those in the medical profession are held to and how
those standards are enforced by your agency. The Health Insurance Portability and
Accountability Act (HIPAA) is a patient privacy law within OCR’s jurisdiction. As such, OCR is
responsible for investigating nursing home abuse allegations relating to privacy, which would
include exploitation of residents via photography.
The Centers for Disease Control and Prevention (CDC) reports that the “physical and
psychosocial consequences of elder abuse are numerous and varied.”7 It is unclear what is being
done to ensure that these consequences are avoided. Reports have stated that OCR could act in
these situations as part of their authority to enforce HIPAA, but it is not clear what OCR has done
to protect against the threats to patient privacy and dignity that are put at risk by irresponsible and
abusive use of social media.8
As technology and social media expand, we owe it to our nation’s elderly population to
ensure quality nursing home care, which debasement of patients does not fulfill. Therefore, I
would like to know more about what rules and protections are in place to prevent and punish these
types of abuses. Please answer the following questions and provide the requisite information:
1. Are the nursing home abuses that occurred in Hubbard, Iowa violations of
HIPAA? Please explain. If not, why not?
2. OCR has stated that it intends to issue guidance with respect to HIPAA and the use
of social media. When will that guidance be issued?
3. In the past five years, how many of OCR’s investigations dealt with HIPAA
violations in nursing homes related to social media use? Of those, how many
resulted in civil penalties or referral to the Department of Justice for criminal
prosecution?
4

Charles Ornstein and Jessica Huseman, Nursing Home Residents Being Exploited Online – Legally, The Des
Moines Register (Jul. 14, 2016) available at
http://www.desmoinesregister.com/story/news/health/2016/07/14/nursing-home-residents-being-exploited-onlinelegally/87023610/
5
Id.
6
Id.
7
Elder Abuse: Consequences, Centers for Disease Control and Prevention, Injury Prevention & Control: Division of
Violence Prevention, http://www.cdc.gov/violenceprevention/elderabuse/consequences.html (last visited Jan. 28,
2016)
8
Ornstein, Nursing Home Residents Being Exploited Online – Legally, available at
http://www.desmoinesregister.com/story/news/health/2016/07/14/nursing-home-residents-being-exploited-onlinelegally/87023610/

 Director Jocelyn Samuels
August 3, 2016
Page 3 of 3

4. On OCR’s website, it notes that as of May 31, 2016, 575 criminal referrals were
made to the Department of Justice relating to HIPAA. 9 Of those, how many dealt
with HIPAA violations in nursing homes? Of those, how many involved social
media related abuse?
5. When an employee of a nursing home engages in activity that potentially violates
HIPAA, what are the requirements of the nursing home to report that activity?

Thank you in advance for your cooperation with this request. Please number your
responses according to their corresponding questions and respond no later than August 17,
2016. If you have questions, please contact Josh Flynn-Brown or Paul Junge of my Committee
staff at (202) 224-5225.

Sincerely,

Charles E. Grassley
Chairman
Committee on the Judiciary

9

U.S. Department of Health and Human Services, Enforcement Highlights, available at
http://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/data/enforcement-highlights/index.html