Am I On Camera? No Paparazzi Please!

[Bridgid Joseph]

There have been lawsuits and stories galore about HIPAA violations related to healthcare practitioners taking pictures of interesting wounds, markings, tattoos, etc. on patients, and when patients found out, they became upset and sued for violations of their privacy. If you are a patient with an interesting medical case, there are two ways it can go: you want to hide under a rock and just get treatment, or you may be interested (especially at a teaching hospital) in having your case discussed at multiple levels and allow pictures of every step of your case so that others can learn from what you experienced.

I understand both sides, which is why most hospitals, if not all, have releases that patients can sign for medical use of photographs (as part of the medical record) so that patients are aware pictures may be taken, but they are being used for medical educational purposes. Patients have the ability to approve or decline the use of pictures, and it gives them that power of decision over their body, in a time when they can feel helpless, which is crucial for them.

Recently there has been a new trend that I have seen at my own hospital, but heard about from various nurses throughout the country, and it is the reverse: patients (or their families) taking videos and pictures of healthcare providers, during routine care and/or family meetings without telling them. During family meetings, especially if a patient is in a critical care unit and family members may be making decisions for a loved one who cannot make decisions for themselves; they may be stressed during the conversation, worried if they are making the right decision and wanting to remember every word of the conversation to relay to other family members to explain their decision making process, but does that give them the right to secretly record our conversation?

I don't think there is anything to hide, but I can also understand how healthcare providers might feel worried that if they are recorded, or videotaped, that this somehow might put them in a position for a possible litigation later on, especially if the outcome of the patient isn't what their family hoped for (and we all know that healthcare providers do the best they can, but we cannot save everyone.)

As for being videoed during routine care of a patient; I don't see what the benefit is for the family, or for the patient. I don't videotape my mechanic when I get an oil change, I trust that they are the expert: they remove the old oil, put new oil in, and my engine is happy and healthy. Granted, I don't have a great relationship with my mechanic, but videotaping their every move would be weird, and I wouldn't blame them if they declined to be videoed.

Maybe that is a bad example, but as a nurse, I form a relationship with my patient and their family members (or at least I do my best to have a trusting relationship) so I think it is even more of an offensive request to videotape me when I am performing care.

Are they wanting to do it to make sure that I am doing things properly? Will they compare and contrast how each nurse cares for them/their loved one? As we all know, there are variations in nursing care, due to personal style, but that doesn't mean that one way is wrong and another is right, the end result can be the same, even though two nurses might go about care in a different way; to an untrained eye, or someone who has no idea about current evidenced based practice or hospital policy, they might think small variations are important, that aren't.

I know some nurses double glove all the time, for no particular reason other than that if they are, for example, removing an IV, they like to take out the IV and pull in into the top glove to throw it out and remove the risk of dirtying a bed. Other people don't do that, but it doesn't mean the nurse is not removing the IV correctly. Those two scenarios look very different to a layperson.

Nurses normally explain what they are doing with a patient either before or during the process, to not only empower them with knowledge, but to make them more a part of their care; doesn't a family member videotaping this make it seem disingenuous, invasive, and distrusting? Where is the trust and the relationship formed with families/a patient when they tape my interactions?

We give patients the power to approve use of pictures of their medical cases as a part of their medical records, but we have had cases of "secret" videos by families, that we found out about afterwards, but were never asked if it was OK. Where is our power to say no when someone is secretly videotaping us? There is no form that has to be signed, as healthcare practitioners to allow families to record us, and if we allow it, do we then have to worry about possible litigation after the fact, even if they were intended just for informational purposes?

Technology is a great mobility for information and keeping people connected electronically, but there are times we need to leave technology at the door, and connect as humans.

[T-Bird78]

I had a pt bring their spouse and adult child to their appt. When they were done, the MD told all of us they had noticed the adult child was holding the phone in a discreet way and MD believed adult child was filming the entire visit. The way MD demonstrated the phone placement, it seemed obvious to all of us that MD was correct. Adult child, spouse, nor pt asked or mentioned this was going on. MD reminded us to be careful what is said and done because we never know who is filming or recording any visit. I really wish they had asked or at least informed us before or during the appointment. MD was giving results of imaging or labs.

[LadysSolo]

In my state it states you can be recorded where there is no expectation of privacy, and gives the examples of public street or hotel lobby. I believe a hospital room has a higher expectation of privacy than either of those, so I believe there WOULD be an expectation of privacy and recording would be illegal. However, I am not a lawyer.

[cagjlg]

My facility does not allow filming of staff without permission but there is no method of preventing it. I know this because we had a severly injured, comatose patient whose mother and aunt were repeatedly asked (by family & staff) to stop filming the patient against the spouse's express instuctions, who was emphatic that the patient would not want to be on film in that condition. The family situation deteriorated and the two ladies began angrily videoing the staff giving care (the anger being in the running commentary), refusing to leave the room for staff to give personal care, as well as the charge nurse & CNO asking them respectfully to abide the spouse's wishes. You never knew when you walked in if you were going to be accosted with a camera. And that's exactly what it felt like, facing a weapon! They were repeatedly told that they were not able to film us without consent and asked to turn off their phones, but short of having security confiscate the phones, there was not much that could be done, except ask them to leave. It was an extremely uncomfortable time caring for that poor patient!!

[canoehead, BSN, RN]

cajlg- Why wouldn't they be asked to leave? The hospital is obligated to protect their patient's privacy. They were interfering with care. Positive PG surveys are just not going to happen with that group. Kick them out! At least for personal care.

[imenid37]

In PA, people are recording just like everywhere else. It may be something you can easily stop in med-surg, etc. I was not aware of the statute.There was recently a patient situation which makes me think our risk manangers may not have known about it either. In OB, it is a huge challenge. People have the expectation that they can and will record every moment for their birth and the newborn period if they want. They do not ask you or care about your feelings/opinion. They care about themselves and their moment. It is all about them and that is what the hospital tells them.Hospital A may be strict about recording, but hospital B may not enforce any restriction. There is the HCAHPS thing and social media which will still record as negative, patient dissatisfaction with the care is taping is curtailed. People often express dissatisfaction related to things we cannot help, but we still get dinged! If the PA Hospital Association or PA ACOG took a stand across the board, then MAYBE it would stop. I usually do not mind being taped, but I do not want a resuscitation taped or a colleague taped who does not desire taping. It is about respect vs entitlement which is lacking with many patients and families.

[Here.I.Stand, BSN, RN]

I know this because we had a severly injured, comatose patient whose mother and aunt were repeatedly asked (by family & staff) to stop filming the patient against the spouse's express instuctions, who was emphatic that the patient would not want to be on film in that condition

Security should have required them to leave. Not asked. That poor patient's right to privacy and dignity was being violated -- not only by the video'ing, but by their refusal to leave for personal care. Not okay. At all.

[Here.I.Stand, BSN, RN]

cajlg- Why wouldn't they be asked to leave? The hospital is obligated to protect their patient's privacy. They were interfering with care. Positive PG surveys are just not going to happen with that group. Kick them out! At least for personal care.

Agree completely. I don't give the survey a thought when delivering care, but I'm any case these relatives wouldn't be filling out a survey. The survey would come to the pt's home. Her husband would have been the one to fill it out if she wasn't able.

If nothing else, they should worry what he had to say, not these cell phone wielding mosquitos.

[Guest838984]

I once was recorded when working the ER one night and it was extremely busy and so one of my admits had gotten a bed upstairs but an ambulance was coming in and my room was the only one opening up so we rolled her out into the hallway for literally 5-10 minutes before the tech rolled her upstairs so the ambulance could have a place to go. and we told her we were putting her in the hallway for 5 minutes before we rolled them upstairs and she took it as being treated unfairly and that she shouldn't have to sit in the hallway and she recorded me and the tech rolling her into the hallway without us knowing and said she was going to try and sue us for putting her into the hallway. I just rolled my eyes and attended to my new ambulance as the tech finally got to roll her upstairs. the tech later found out she recorded us by overhearing her and her husband whisper about it before he came back down. I really think this issue should be addressed because I was severely offended and angry by the whole situation and felt there really is nothing to protect us in a case that a patient would want to sue and use unpermissable videos as evidence in a case.

[iluvivt, BSN, RN]

Simple: say, NO! And hold your hand up or give them the finger, not the pointy one.

Camera's, even the cute ones have no place when giving patient care, unless its an operation.

Let them complain to the boss lady or admin, you have a job to do.

No cell phones are allowed in most hospitals, because of the radio transmitter than can interfere..good god, you should know this.

This is no longer True! At first the thinking was that they could interfere with monitors and pacemakers. The American Medical Association (AMA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA) presently do not condone blanket bans on using mobile phones in hospitals. We have have no ban on cellphones or any wireless devices for that matter and they are everywhere. Some nurses even carry all types of chargers for patents that do not have a means to charge up their phones.

[MunoRN, RN]

I agree that generally people are permitted to record events and people in public places because by definition public places do not confer an expectation of privacy. There is an important distinction between public places and hospitals that is being overlooked here: Hospitals are not automatically legally defined as public places.

Some may be, depending on who owns and administers them (VA comes to mind), but privately held hospitals are not "public". The owners/operators of those facilities have the right to determine the scope and extent of permitted recordings, if any.

I think you're confusing public/private property with places of public accommodation, which are two different things. Most places of public accommodation are private property (stores, restaurants, etc), but in terms of an expectation of privacy they are considered public spaces since they are places of public accommodation.

Places of public accommodation are free to have rules about how people must act while in their establishment, but it's very important to recognize the difference between those rules and enforceable laws. If a facility has a policy against wearing hats and someone wears a hat into the hospital, can you have them arrested for wearing a hat?

[MunoRN, RN]

Its not just a question of expectation of privacy - statutes can and do prohibit recording without consent. In PA for example, it is illegal to make an audio recording without the consent of all parties. Period. There is no exception for recording a nurse speaking to a patient. If a nurse (or anyone) did not consent, or was not given the opportunity to do so- that recording would be in violation of the law regardless of where it occurred in the hospital or care setting. Unfortunately, PA is probably the exception when it comes to the strictness of its non-consensual recording laws.

There are laws against surreptitious audio recording; audio recording without someone's knowledge. If the person is using some sort of hidden device then that would violate those laws, holding a cell phone up in a manner that makes it obvious you're recording the person talking to you isn't secretly recording them since it's not secret at that point. You are free to refuse to speak while being recorded if you chose.

[Ruby Vee, BSN]

This is no longer True! At first the thinking was that they could interfere with monitors and pacemakers. The American Medical Association (AMA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA) presently do not condone blanket bans on using mobile phones in hospitals. We have have no ban on cellphones or any wireless devices for that matter and they are everywhere. Some nurses even carry all types of chargers for patents that do not have a means to charge up their phones.

Since you cannot ban cell phones, at least don't enable the practice of recording. Nurses aren't obligated to help them charge their devices, and they certainly aren't doing their colleagues any favors by making it easy for the abuse to continue.