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Let's say you had a workman at your house, and they left the garage door unlocked when they were finished. If you come home and everything is fine, then there is no cause for legal action. If you come home and your house has been robbed, then first it's the robber's criminal act, and then maybe there's a civil action by your insurance company to get money from the workman's insurance company.
The hospital is seen as the *victim* of a theft, just as if a doctor's or psychiatrist's office were broken into for drugs and some records were stolen, rather than a *culprit* for "failing to maintain HIPAA confidentiality". YOU have to go after each person who does something illicit with the information; each marketer, each fraud instance, each problem, is individual. And since each of them is small individually, it's YOUR burden to chase them as a civil matter rather than a criminal matter that would get you some help from society (through the police agencies).
Why is everything a slippery slope for you people? Is it not possible that we find a middle way?
I wish, with all my heart, that we could always rely on reasonable people to take reasonable positions and make reasonable use of power. All it takes is for an unreasonable person to attain a position of power, or even for a reasonable person to be misled by unreasonable people controlling the flow of information, for power to be abused. Put this power in the hands of a reasonable person, and his successor (or two or three) could be a religious zealot or some other kind of fanatic. I categorically find the idea of "kiddie porn" vile and disgusting; and at the same time I'm willing to bet that many families have photos of naked babies, or children in the bathtub, or teens changing in a towel on the beach, that are purely childish mementos - except that by some technical literal criteria, the nudity and age could be counted as kiddie porn. Not to mention differing cultural standards: in the US a national magazine cover can show a girl in a teeny bikini but the slightest glimpse of nipple is forbidden, while in some countries a girl needn't bother with a top at all.