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Case Study: HIPAA violation or not?

HIPAA   (2,355 Views | 15 Replies)
by Allmy? Allmy? (New) New

Allmy? has 1 years experience .

297 Profile Views; 2 Posts

Scenario:

    A student took a picture of a patients wound during clinicals, we are unsure if consent was given. The student then showed the pressure wound to the class at a break. Should she be reprimanded for this action or no harm was done? is this a HIPAA or PHI violation? Ethical or legal?

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DisneyNurseGal has 8 years experience as a BSN, RN.

568 Posts; 11,797 Profile Views

I don't think it's a HIPPA violation per se; however it is a privacy violation.  I don't feel like pictures should never be taken of a patient's body ... ever.  Would you feel different if the student took a picture of a patient's body part and used it to make fun of it?  Doesn't matter the intent of the reason to take the picture.

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Ruby Vee has 40 years experience as a BSN and specializes in CCU, SICU, CVSICU, Precepting & Teaching.

11 Followers; 66 Articles; 13,948 Posts; 172,251 Profile Views

What's the school's policy on photographs?  What is the hospital's policy on photographs?  

Photographs are often taken of patient's wounds with the express purpose of documenting wound healing.  They are taken by the wound nurse team, with permission of the patient and/or the patient's decision maker.  Photographs are also quite reasonable for teaching purposes.  A student taking the picture, however, seems like a good way to get kicked out of school.

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mrsboots87 has 3 years experience and specializes in Neuro, Telemetry.

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Picture taking of anything in a patient care area (patient or otherwise) was expressly forbidden when I was in nursing school. Would have been terminated from the program for it. Taking pictures of a patient for documentation requires a signed consent from the patient. I would imagine it is the same for a student to do so for learning purposes. Read the nursing school handbook. I can almost guarantee that there is a policy about this that that student just violated. 

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kakamegamama specializes in MCH,NICU,NNsy,Educ,Village Nursing.

1,021 Posts; 15,792 Profile Views

Is this a homework assignment, or a real event that happened in your clinical?  If the former, what do YOU think?

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OldDude specializes in Pediatrics.

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It is a violation of everything. The wound itself could identify the patient...no consent, etc.

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Jory has 10 years experience as a MSN, APRN, CNM.

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1 hour ago, DisneyNurseGal said:

I don't think it's a HIPPA violation per se; however it is a privacy violation.  I don't feel like pictures should never be taken of a patient's body ... ever.  Would you feel different if the student took a picture of a patient's body part and used it to make fun of it?  Doesn't matter the intent of the reason to take the picture.

It's a HIPAA violation.  Patients consent for photographs to be taken by medical staff for the chart, wound care, etc.  They don't consent to the pictures for show and tell by a student for show-and-tell.  

Now if a teacher took the picture to show class...that is different...education is protected, but she still needs permission of the hosting facility.  

People think that identifying information is required for a HIPAA violation.  It's not.  People have the right to not have unauthorized pictures taken of their bodies (taking the picture was a privacy violation), sharing the picture in class was a HIPAA violation.

 

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verene is a MSN and specializes in mental health / psychiatic nursing.

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29 minutes ago, Jory said:

It's a HIPAA violation.  Patients consent for photographs to be taken by medical staff for the chart, wound care, etc.  They don't consent to the pictures for show and tell by a student for show-and-tell.

I think the "by a student" piece is critical - when I was a patient at a teaching hospital the consent form I signed *did* allow me to opt in/out of having pictures and recordings taken of my care for the express purpose of student teaching & learning including being included into case presentations for students of the affiliated medical school.

I think what the student did in this instance likely violates both hospital and school policies around information and around patient privacy (let alone use of phones in a clinical area). However, I am not sure it is a HIPPA violation because we would need to know if the wound itself counts as "uniquely identifying information".  Non-face images are sometimes not considered HIPPA protected information if the image is otherwise scrubbed of identifying information because it is unlikely the specific patient could be identified on the basis of the image alone.

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Tenebrae has 8 years experience as a BSN, RN and specializes in Mental Health, Gerontology, Palliative.

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Very bad idea for a student to do anything like that. Great way to get kicked out of school

 

I will take a picture, with the patients verbal permission, for a specific reason eg to document a wound progress, or if I'm sending a referal for specialist wound consult and I explain that to the patient, what I am going to do with it, reassure them I wouldnt post it on facebook. If the patient says no, then the photo doesnt get taken.

 

However its with no identifying details and documented in the patients notes that they gave consent

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58 Posts; 885 Profile Views

I am pretty sure taking photographs on personal gadgets is forbidden without consent, especially showing it to a class of nursing students. You'd need signed consent for that at least.

I've used my phone to take a picture once when our blood gas machine cocked up and wouldn't print so I quickly took a photo of the result to show the doctor before it logged me out. I've also had my phone camera at the ready to try and video seizure activity in a baby that had a queried seizure and we were watching for further, parents knew I'd video it for the doctors. Everything is deleted though afterwards and I definitely would NOT be allowed to use that video to 'show' anyone random what a seizure looked like. 

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Jory has 10 years experience as a MSN, APRN, CNM.

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10 hours ago, verene said:

I think the "by a student" piece is critical - when I was a patient at a teaching hospital the consent form I signed *did* allow me to opt in/out of having pictures and recordings taken of my care for the express purpose of student teaching & learning including being included into case presentations for students of the affiliated medical school.

I think what the student did in this instance likely violates both hospital and school policies around information and around patient privacy (let alone use of phones in a clinical area). However, I am not sure it is a HIPPA violation because we would need to know if the wound itself counts as "uniquely identifying information".  Non-face images are sometimes not considered HIPPA protected information if the image is otherwise scrubbed of identifying information because it is unlikely the specific patient could be identified on the basis of the image alone.

Think of it this way...what if it was a genital injury, would you feel the same?

Your body is your own....internally, externally.  You have the right to not have unauthorized pictures taken by students.  

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12 Followers; 3,826 Posts; 28,882 Profile Views

Personal device + picture + patient do not ever go in the same sentence together.

Right or wrong, all of you who are using your personal devices in what you believe are legitimate ways of assisting your work are just one wrong day/wrong person away from being out of a job. If it benefits your work/workplace for you to take pictures of anything for any reason, there should be a workplace device for accomplishing that.

It was not ethical and proper procedures were not followed for taking photographs for educational purposes.

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