The big story from the crime beat this past week is the arrest of Whitey Bulger — a notorious crime boss from South Boston. Never heard of him? Not surprising if you’re not from Boston. But if you have lived there, his arrest was probably a bigger deal that the nabbing of Osama Bin Laden. His life of crime was the inspiration for the movie The Departed; he would have been Jack Nicholson’s character Frank Costello. And, in fact, Bulger was supposedly an FBI informer, but ratted out his competition. Most likely he was tipped off that his arrest was imminent causing him to flee. Since 1994 he has been a fugitive and number one on the FBI’s most wanted listed. (His life as a crime boss and his brother’s long term tenure as a state senator also was the idea for the Showtime series The Brotherhood.)
But why, you might ask, with all the great things to blog about, would I blog about this? Glad you asked. In the search for him, the FBI adopted a novel approach, which focuses more on his long-term girl friend, Catherine Grieg. She had had several plastic surgeries including breast augmentation with silicone implants.
Several months ago a full page add was run in our monthly periodical, Plastic Surgery News, showing both Bulger and Grieg, in case they or she ended up in one of our offices for either a replacement of the implants, or other operations. They also began targeting other aspects of the beauty industry with public service announcements asking for tips on them. Ultimately a tip from someone in, I assume, Santa Monica– where they had been living for the last ten years– lead to their arrest. They had been living in a rent controlled apartment for which they paid $1200 rent in cash each month. But over 30 weapons and $800,000 in case were found in their “humble” abode. Methinks they got the right guy.
An Ethical Dilemma
But reaching out to plastic surgeons in an interesting, and possibly controversial approach. Obviously the hope was that we could identify her from her appearance, or the lot number on her silicone breast implants (a long shot in my view) or identify him from his appearance. Here’s the problem: where does patient confidentiality fit in with all this? If the tip had come from a salon where Grieg went to have her nails done, this might not be a big deal. But suppose she came in to my office in Knoxville, Tennessee for breast implant replacement. Most likely if I had recognized her, I would have contacted the FBI. But would I, as a physician, be at fault for disclosing her identity to another authority or individual? (I think HIPPA would have something of a dim view of this.) No doubt, if I had tipped someone off, and she was the right person, and the FBI’s most wanted fugitive was apprehended, no one would cry foul. But let’s just suppose that I had tipped of the FBI to someone that was a dead ringer for her, but who turned out not to be her. What then?
To me this is not a straight forward issue. Patient confidentiality is key, even if it were not mandated by HIPPA. As a physician, and as a plastic surgeon, this is paramount. Few people would consult with a plastic surgeon if they did not feel their information was private and protected — nor should they. But this is obviously a singular case, and the “greater good” must be taken into consideration. The right course through this rocky passage is not at all clear. This is somewhat like a case of a person who tells a psychiatrist that they are going to commit a crime. I can only hope that this does not become a common FBI tactic in apprehending criminals.
But what are your thoughts? Where does the responsibility for patient confidentiality end and the concern for the greater good begin?
All the best,